a medical librarian's adventures in evidence-based living

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Note: This is a very long post that includes the latest FDA statin warnings, as well as posts I have previously written that explain in more detail the side effects of statins--what they are, why they occur, and what increases your chances of experiencing them.

Last Week's Breaking News: FDA adds warnings to statin labels

While Drs. Steven Nissen & Marc Gillinov new book, "Heart 411: the ONLY Guide to Heart Health You'll Ever Need", minimizes the adverse effects of statins, the FDA has finally decided to publicly alert us to two of statin's more alarming side effects. All statins will now have label warnings to the effect that high-dose statins significantly increase the risk of diabetes, and statins can have cognitive side effects, albeit reversible.

Steven E. Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, said, "There is no question that statins slightly increase the risk of a diabetes diagnosis and of slightly higher blood sugar, but I think this has no impact on the risk-benefit assessment. I know I can lower the [relative] risk of death, stroke and heart attack by about 30%" in patients at high risk of such cardiovascular events. (WSJ 2/29/12) Read the WSJ article here.

Dr. Eric Topol, one of the country's top cardiologist, and the former chairman of cardiology at the Cleveland Clinic (now at the Scripps Research Instiute) wrote a "must read" Op/Ed piece in the New York Times on March 4, 2012,The Diabetes Dilemma for Statin Users, with a decidedly different view of diabetes risk associated with statins.

Dr. Beatrice Golomb of the University of California at San Diego, has been running one of the largest observational studies on adverse effects of statins for years--providing a database for people all over the world to self-report any side effect to statins that they have experienced. Read more about her work at UCSD here.

Statins are the most-prescribed drug on the market, with almost 21 million prescriptions written for them last year. There is no doubt that they are a life-saving drug for many--particularly for anyone who has already suffered a heart attack. However, their side effects appear to increase, as the dosage increases, and as patients get older.

It's time to recognize that muscle aches, weaknesses, & even some cognitive dysfunction can't always be blamed on a patient's age. Sometimes the statin is to blame.

If a radical shift in one's diet can lower cholesterol, blood pressure, reduce the risk of heart disease & diabetes, and decrease inflammation--maybe it's time more people knew about it--and received the right education, coaching, & support to do something about it.

It's interesting that one prominent cardiologist recently said it was a lot cheaper to prescribe low-cost statins than it was to coach patients in diet & exercise! He's right.

Excerpt from Topol's, "Diabetes Dilemma for Statin Users"

"We’re overdosing on cholesterol-lowering statins, and the consequence could be a sharp increase in the incidence of type-2 diabetes. Statins have been available since the 1980s but their risk of inducing diabetes did not surface for nearly 20 years.

For those statins [Zocor, Lipitor, & Crestor], the higher the dose, the more diabetes, though we don’t have enough data yet to say with precision at which dose excess diabetes showed up for each drug. What we do know is that diabetes showed up.

More than 20 million Americans take statins. That would equate to 100,000 new statin-induced diabetics. Not a good thing for the public health and certainly not good for the individual affected with a new serious chronic illness.

The announcement, medication label change and health advisory by the F.D.A. were long overdue, and have brought this important public health issue to light.

The information that we have does not support that this is a “small” problem unless one considers more than 100,000 new diabetics insignificant. The problem of statin-induced diabetes cannot be underplayed while the country is being overdosed." (NYT March 4, 2012)

-Dr. Eric J. Topol is a cardiologist at the Scripps Clinic, a professor of genomics at the Scripps Research Institute and the author of “The Creative Destruction of Medicine”-

Excerpt from Parker-Pope's "A Heart Helper May Come at a Price"

“Thinking and remembering became so laborious that I could not even recall my three-digit telephone extension or computer password at work,” said [Steve] Colburn, 62, a sales representative and product developer [from Portland, Oregon].

“All day, every day, I felt like my brain was mush.”

His doctor suggested a “drug vacation,” and when Mr. Colburn stopped taking the statin for six weeks, the problems disappeared. Then he tried a different statin at a high dose, but the cognitive difficulties returned. His doctor has since lowered his dose by more than half, and while the memory lapses have not disappeared, he has learned to cope.

Bill Moseley of Towson, Md., tried taking statins to lower his cholesterol; he also began taking medications for hypertension and high blood sugar. He found the drugs to be mind-numbing.

Against his doctor’s advice, Mr. Moseley in 2006 stopped all of the drugs and began focusing on healthful eating and exercise, meeting regularly with a personal trainer and lifting weights. Four months later, the cognitive problems disappeared. Today, he is 69, his cholesterol has dropped from 225 to about 125, and his blood pressure and blood sugar are under control.

-Tara Parker-Pope, "A Heart Helper May Come at a Price"-

Here's the HeartWire Press Release on Statin Label Warnings

February 28, 2012 Reed Miller

Silver Spring, MD - Taking a statin can raise blood sugar and glycosylated hemoglobin HbA1c levels, according to a new labeling change approved by the Food and Drug Administration (FDA) today for the entire drug class. [Read the FDA warning here]

As reported by heartwire, recent studies of popular statins showed a significant increase in the risk of diabetes mellitus associated with high-dose statin therapy.

The labeling changes approved by the FDA also include new information on the potential for usually minor and reversible cognitive side effects. Also, the label for lovastatin has been significantly updated to provide information on contraindications and dose limitations for the drug in patients taking other medicines that may increase the risk for muscle injury.

The agency is advising healthcare professionals to perform liver-enzyme tests before initiating statin therapy in patients and as clinically indicated thereafter (and not necessarily on a routine basis). Statin therapy should be interrupted if the patient shows signs of serious liver injury, hyperbilirubinemia, or jaundice. The statin therapy should not be restarted if the drugs cannot be ruled out as a cause of the problems, the labeling will now state.

Sorting Out the Statin & Diabetes Connection

Excerpts from My Previous Posts about Diabetes-Statin Research

Over the past two years, at least three articles have been published in major medical journal linking statins to increases in diabetes: Lancet, JAMA, & now theArchives of Internal Medicine. These studies have been based on analyzing data from large long-running studies, including the Women's Health Initiative.

"The results — a nearly 50% increase in diabetes among longtime statin users (compared to those not taking a statin) — should throw cold water on the idea of prescribing these drugs to healthy people, which some have recommended as a way to prevent disease," says Archives of Internal Medicine co-author JoAnn Manson, a professor of medicine at Harvard Medical School.

All three studies controlled for confounding variables, to ascertain if the diabetes was medication driven.

"Since individuals using statins may have different underlying conditions that could put them at elevated risk for [diabetes], we conducted several subgroup analyses to control confounding by indication." All studies have limitations & the researchers can't be sure if different statins might have different effects given the time frame of the study--and the drugs that were used at the time.

The recent Archives of Internal Medicine study noted that women, the elderly, & Asians are at a higher risk of diabetes from statin use. One thing is certain--statin use won't prevent diabetes--diet, weight-loss, & exercise (especially, when it includes weight-training) will help.

The results a nearly 50% increase in diabetes among statin users raises concerns about prescribing these drugs to healthy people.

Excerpts from the Lancet & JAMA studies: The Higher the Dose of Statins, the Higher the Risk of Diabetes--The Reasons are Unclear

"Last year, Lancet published an analysis of major statin trials involving 90,000 patients that showed statin users had a 9 percent higher risk of developing diabetes than those who didn’t take statins. But questions remained about whether the effect was real or something that may have just been due to chance." NYT June 21, 2011

Now, "a just-published meta-analysis of some of the more high-profile statin trials testing the effectiveness of high-dose therapy has revealed a significant increase in the risk of diabetes mellitus associated with statin use in high doses.

Compared with moderate-dose therapy across five statin trials, investigators report that treatment with high-dose statins increased the risk of diabetes by 12%, which translates to a 20 percent overall increased risk of diabetes for high-dose statin users, compared to those who don’t take the drugs, according to the study’s senior author.

Senior investigator DrKausikRay (St George's University of London, UK) said that while there might be consequences from the raised blood glucose levels, researchers do not yet know what these long-term effects mean.

The net benefit of high-dose statin therapy "is definitely in favor" of using the drugs, he said.

'One thing we do know is that there does appear to be a dose effect with statin therapy, with the risk of diabetes mellitus increasing with higher doses,' Ray told Heartwire.

'Statins have multiple effects and cause a number of changes. What we're seeing is probably an off-target effect, and right now we have no obvious mechanisms.

The researchers have no clear explanation for why statins raise the risk of diabetes as the doses go up.

Is it possible that statins aren't to blame for the rise in diabetes risk?

Could it be as simple as the eating & lifestyle habits of high-dose statin-takers.

Do statins make people worry less about what they eat, or how much they exercise--knowing that the statins will easily take care of their cholesterol for them?

Do they think statins will protect them from the negative effects of weight gain, food indulgences, or lack of exercise? Could that account for the increased risk in diabetes as statin doses rise?

A one NYT's commenter confessed:"Perhaps the reason people who take statins are at a slightly higher diabetes risk is because the statin - which has clearly demonstrated its effectiveness in lowering cholesterol levels- may provide one with the mirage of safety when it comes to deciding whether to avoid a food of questionable nutritional value.

I take statins and I know I eat more red meat than I would if I didn't take statins. I might also cheat a bit more on the sugar-based foods as well. Perhaps I should take my head out of the sand!"

What The Experts Say About The Side Effects Of Statins. What Are They? What Causes Them? Who Is Most At Risk? How Are They Treated?

(originally posted on HHLL on June 27, 2009)

"Muscle problems are the best known of statin drugs' adverse side effects. But cognitive problems and peripheral neuropathy, or pain or numbness in the extremities like fingers and toes, are also widely reported."

"Because statin-related myopathy will probably become more common with greater numbers of persons starting high-dose statin therapy and the increasing stringency of low-density lipoprotein cholesterol level targets, research to better identify patients at risk for statin myopathy and to evaluate management strategies for statin-related myopathy is warranted."

Dr. Tisha R. Joy, MD, and Dr. Robert A. Hegele, MD, Robarts Research Institute and Schulich School of Medicine, University of Western Ontario, London, Ontario, CanadaAnn Intern Med 2009 June 16;150(12)858-868

"Those of us who care for patients who cannot tolerate lipid-lowering therapy are often confronted by anecdotes that contradict the findings of well-designed trials. We still do not know whether statins directly induce muscle atrophy or whether lowering lipid levels by any means in patients with vulnerable muscles causes myotoxicity."

There's no doubt about it. Statins provide a tremendous benefit by lowering cholesterol and inflammation and decreasing the incidence of cardiovascular disease.

But...our bodies are all different. Even the statins, drugs hailed to have a high safety profile, also have the potential for causing adverse effects in some of us--dependent on the dosage, drug interactions, co-existing medical conditions, age, genetics, activity level, gender and other factors.

If you've had questions about the side effects of statins, these four recent articles will definitely give you a better understanding of who experiences statin problems, what might cause the problems, and how to deal with them.

Many of these side effects could be easily dismissed or assumed to be related to something else. Better to be forewarned. According to Dr. Beatrice Golomb, the expert on adverse effects, "physician awareness for adverse effects is reportedly low, even for those most widely reported by patients."

Golomb and Evans' "Statin Adverse Effects. A Review of the Literature and Evidence for a Mitochondrial Mechanism"

Golomb is one of the top experts on the adverse effects of statins. She has previously conducted a "randomized controlled trial" of persons living in San Diego, examining effects of low dose statins on thinking, mood, behavior, and quality of life. Additionally, she runs one of the largest observational studies on adverse effects of statins--providing a database for people all over the world to self-report any side effect to statins that they have experienced. Read more about her work at UCSD here.

Her paper is the first comprehensive review of the subject, covering almost 900 studies on the adverse effects of statins. It's an exhaustive analysis of the research, including the most highly regarded of studies, the randomized controlled trial.

2. Second most common statin complaint:Cognitive problems: memory, thinking & concentration, problems finding the right word, experiencing "holes in one's memory". Since most people are older when starting on statins, this is often difficult to distinguish from age-related memory loss, but Golomb says many have reported that their thinking & memory improves when they stop statins, or lower the dose. Read "Do Statins Make You Stupid? Asks Wall Street Journal and the New York Times" for more on Golomb's research.

4. What's causing the problems? According to Golomb, statin-induced injury to the body's "energy-producing cells"--the mitochondria, is the root cause of many of statin's adverse effects. When the mitochondria are impaired the body produces less energy and we end up with more damaging "free radicals". Additionally, statins lower the body's production of co-enzyme Q10, a key component in the mitochondria that is necessary to produce energy & destroy "harmful free radicals". To make matters even worse, there is a real Catch-22: Statins not only lower our CoQ10 levels, but they also reduce our blood cholesterol which is the way CoQ10 and other fat-soluble antioxidants are transported throughout the body. So, not only do we end up with low CoQ10, when our cholesterol is lowered, the CoQ10 has difficulty moving through the body.**According to Golomb, there is evidence that this mitochondrial/CoQ10 connection relates to both muscle & brain pathology.

5. Age and adverse effects. Now throw in the fact that as we age our mitochondria (the energy powerhouses) naturally weaken, and we produce less CoQ10--adding statins to the mix may not always be wise. According to Golomb, "The risk of adverse effects goes up as age goes up, and this (the mitochondrial/CoQ10 connection) helps explain why statins' benefits have not been found to exceed their risks in those over 70 or 75 years old, even 'for' those with heart disease."

High blood pressure and diabetes are also linked to higher rates of mitochondrial problems--which in turn ups the risk of statin complications for people with these conditions.

"Because statins may cause more mitochondrial problems over time--and as these energy powerhouses tend to weaken with age--new adverse effects can also develop the longer a patient takes statin drugs." The risks go up as we age, as the dosage increases, and with certain genetic conditions that put one at a greater risk for developing side effects.

Joy & Hegele's "Narrative Review: Statin-Related Myopathy"

This is the quintessential "cookbook" article on statin myopathy. Believe me--this gets very complicated. The authors thoroughly explain what statin-caused muscle pain is. Who is at risk. What causes it. What doses, which statins & circumstances increase the chances of risk. And most importantly, how to make muscle pain go away.

10% of statin users experience muscle pain, but those numbers increase with excessive physical activity (which explains why most athletes avoid statins); when the statin dose increases; the older you get; in women; those with small body frames; with grapefruit juice consumption; in those with a family history of statin myopathy; in certain genetic profiles; with hypothyroidism; and in patients taking certain drugs--just to name a few.

Muscle pain is usually in the thighs, calves or both, but 25% experience generalized muscle pain. The myopathy is described as heaviness, stiffness, or cramping, and is sometimes associated with weakness during exercise. 25% have tendon-associated pain.

Strategies to combat myopathy. Switch statins, particularly to fluvastatin (Lescol); try alternate-day use of certain statins like atorvastatin (Lipitor) or rosuvastatin (Crestor) because they are longer-acting; use of older generation non-statin drugs that work by inhibiting the absorption of cholesterol in the intestine, like ezetimibe and bile-acid-binding resins; and/or supplementing with CoEnzyme Q10.

Phillips' Editorial, "Balancing Randomized Trials With Anecdote"

Phillips is just the right physician to comment on both the Becker/Gordon red yeast rice article and the Joy/Hegele statin-myopathy "cookbook" review. He runs a statin myopathy clinic, which now exceeds 600 patients, at the Scripps Mercy Hospital in San Diego, CA. He knows statin-myopathy well--what works--what doesn't.

According to Phillips, treating statin-myopathy is more of an art--and the clinical trials don't always tell the whole story, or provide clinicians with the best therapies. "Those of us who care for patients who cannot tolerate lipid-lowering therapy are often confronted by anecdotes that contradict the findings of well-designed trials."

Outside of the clinical trials, Phillips' clinic has discovered that vitamin D deficiency explains many mild cases of statin-induced aching.

He's also discovered that absorbable forms of CoEnzyme Q10, which may be depleted by statins, seem to help some patients with muscle pain---but most formulations sold over the counter may be inactive. I'm wondering which formulation he would recommend.

Although clinical trials have convinced many physicians to switch patients with muscle pain over to ezetimibe (bile-acid-binding resins), there are many individual reports that suggest that ezetimbe might not be safe for patients who can't tolerate statins. The reason for this--many of these patients have an abnormal lipid metabolism--rendering both drugs unacceptable.

In spite of the positive results of the Becker/Gordon study, Phillips' experience makes him reluctant to use red yeast rice to lower cholesterol & prevent muscle pain. Why? Red yeast rice is not regulated or dose-standardized and since it contains the natural form of a lovastatin, it could have the potential for causing serious side effects. In his clinic he "sees many patients in whom red yeast rice use has repeatedly caused recurrence of muscle toxicity symptoms, occasionally with increased creatine kinase (CPK) levels."

The red yeast rice study only measured muscle pain. Phillips wants to know--what about the malaise, fatigue, and weakness that he sees in his patients who use red yeast rice?

The FDA continues to warn against inconsistent and possibly toxic formulations of red yeast rice. Phillips advises physicians not to prescribe it until it has been standardized and tested further.

Two other articles to check out:

Siddiqi, SA, Thompson, PD. How do you treat patients with myalgia who take statins? Curr Atheroscler Rep. 2009;11:9-14.

I've never been prescribed, nor taken statins. I know many who take them without a problem. I know others who have experienced side effects that they never considered to be statin-related, but found they went away when they stopped taking statins. I would always recommend discussing this with one's physician, and sharing any of these articles with them, as well. You won't know what questions to ask, if you don't do the research.

Remember, there's always Option 2: Switch to a plant-based diet, and don't worry about side effects.

On February 12, the Wall Street Journal provocatively questioned whether the ever-popular statins we take to protect ourselves from heart disease are causing memory loss, fuzzy thinking or mood disturbances. On February 13, 2008 the New York Times, asked the same question. Can a drug that helps hearts, be harmful to the brain? Are statins making us stupid?

The WSJ reported that Dr. Orli Etingin, the vice chairman of medicine at New York Presbyterian Hospital, and the director of the Iris Cantor Women's Health Center in New York, was speaking at a Project A.L.S. luncheon when she declared, "This drug makes women stupid."

Dr. Etingin told about the typical patient in her 40s, who after starting on statins is unable to concentrate or recall words. When tests show nothing remiss, and she goes off Lipitor, the symptoms vanish. When she starts back on them, the symptoms come back. Dr. Etingin says, "I've seen this in maybe two dozen patients. It's just observational, of course. We really need more studies, particularly on cognitive effects and women."

Most cardiologists see little cause for concern. "The benefits outweigh the risks," says Antonio Gotto, dean of the Weill-Cornell Medical School. "I would hate to see people frightened of taking statins because they think it's going to cause memory loss."

However, at the University of California at San Diego, researchers soon may be able to shed further light on whether or not statins can cause these disturbing memory/thinking/mood disturbances. They're nearing completion of a(the gold standard) randomized-controlled trial that looks at the effects of statins on thinking, mood, behavior, and quality of life. As a separate piece of this project, the UCSD group is collecting anecdotal reports of patients on their experiences with statins. With 5000 reports so far, muscle aches are the number one complaint and memory problems are number two. You can check out the UCSD Statin Effects Study here.

The UCSD lead investigator, Dr. Beatrice Golomb, says they have some very compelling cases linking statins with memory loss. Because these patients regained their memory and concentration once they went off the statin, it's very hard to chalk up the memory problems to just getting older. She gives the example of a 69 year old San Diego woman, named Jane Brunzie, who became so forgetful that her daughter wouldn't let her babysit for her granddaughter. She started to think her mother had Alzheimer's. Within 8 days of going off her statins her memory problems ended. But three more times her doctor started her up on a different statin, and within days, once more she had problems with getting the right words out. When she finally stopped the statins all together, she was back to herself within eight days.

There have been alot of observational reports and talk about these cognitive side effects for years, but the drug companies say there is no causal link between the two.

In fact, a couple years back there was research on how often doctors actually minimize or dismiss the uncommon statin side effects their patients report to them, especially, if the side effect isn't listed on the drug's package insert. Guess what, side effects like memory loss, fuzzy thinking, and sleepiness, aren't on the Lipitor package insert.

There's no question that statins are necessary and can prevent future heart attacks and possibly strokes in high-risk patients, who actually have occlusive vascular disease. But since 2001 the number of people who are taking statins has skyrocketed. What used to be prescribed for those with vascular disease, is now prescribed for primary prevention in healthy men and women, who might be at risk of a "future disease".

This all started in 2001, when the US National Cholesterol Education Program's (NCEP's) guidelines changed the recommendations of who should start taking statins. Even for those of us who have no heart or vascular disease, depending on what other risk factors we have, like age (over 45 for men, over 55 for women), a family history of early heart disease, low HDLs, blood pressure over 140/90 mm Hg, or smoking, it's possible that we could be considered at moderately high risk if our LDLs are over 130, with an option to start statins for those of us with an LDL of over 100. So all of a sudden the number of Americans who are "eligible" to be on statins has grown from 13 million people to a possible 36 million.

Our analysis suggests that lipid-lowering statins should not be prescribed for true primary prevention inwomenofanyage or for men older than 69 years. High-risk men aged 30-69 should be advised that about 50 patients need to be treated for 5 years to prevent one event.

Statins did not reduce total coronary heart disease events in 10,990 women in these primary prevention studies. Similarly, in 3239 men and women older than 69 years, statins did not reduce total cardiovascular events.

What could be the possible explanation of these cognitive side effects?

For one thing, cholesterol plays a crucial role in making sure our brains work properly and our brains are primarily made of cholesterol. However, the brain can't obtain cholesterol from our blood. It manufactures it from its own glial cells, which are responsible for stimulating the brain to make connections (synapses) that are essential for learning and memory. Could it be possible that lowering cholesterol with a drug, artificially, is different from lowering cholesterol naturally, with diet & exercise? Could statns somehow be blocking the brain's natural production of necessary cholesterol?

The Bottom Line here, I'd take the advice of Dr. Nieca Goldberg, a cardiologist and the medical director of the Women's Heart Program at New York University School of Medicine:

She prescribes statins only for women who have elevated cholesterol and have had a heart attack. But for younger women with high cholesterol and no other risk factors, it's lifestyle changes, diet modifications and physical activity.

For the NYT article and the interesting list of comments, including mine (#25) click here.

So there you have it. Looks to me like there are plenty of good reasons to give serious consideration to a plant-based oil-free diet & exercise to lower cholesterol & prevent heart disease or stroke! But, that's just my opinion.

January 31, 2012

If you received this post via email, click here, to get to the web version with all the links

The Back Story

I was "introduced" to Dr. Gabe Mirkin about 10 years ago.

He kept me company on the long rides home from the hospital, on nights when I had to work late.

His evening medical talk radio show was the only decent thing to listen to on the radio after 9:00 pm--back in the pre-podcast/iPod/iPhone days. And let me tell you, I had to really search hard to pick up his broadcast on CKLW--an AM station out of Windsor, Ontario.

Dr. Mirkin has since retired, and no longer shares his medical updates on the radio--but, I still keep up with him via his weekly E-Zine Newsletter--and so can you! He shares "what's new in the medical literature" in the areas of:

Sports, fitness & exercise

Diet and wellness

Lifestyle changes to maximize health

Who is Dr. Gabe Mirkin

He was a practicing physician for more than 40 years--and a radio talk show host for 25. Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is one of a very few doctors board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology.

Dr. Mirkin did his residency at the Massachusetts General Hospital and over the years he has served as a Teaching Fellow at Johns Hopkins Medical School, Assistant Professor at the University of Maryland, and Associate Clinical Professor in Pediatrics at the Georgetown University School of Medicine.

Dr. Mirkin has run more than forty marathons and is now a serious tandem bike rider with his wife, Diana, often doing 30-60 miles in an outing. Read more about Dr. Gabe Mirkin in his curriculum vitae.

Dr. Gabe Mirkin & Wife Diana--Tandem Cycling Enthusiasts

When I read the short piece Dr. Mirkin wrote on type-2 diabetes in his E-zine for January 29, 2012, I decided to just share it in its entirety. It's short. It's simple. And it's worth repeating.

Ditch the sugar, the high-glycemic processed carbs--and go for the whole unprocessed high fiber carbs. According to the world-renowned diabetes researcher, Jennie Brand-Miller PhD, who runs the Glycemic Index database out of the University of Sydney in Australia, the number one best food you can eat for breakfast is steel-cut oats! Low-glycemic, high fiber, slow-burning satisfying carbs. If you haven't tried my chocolate oatmeal yet--you don't know what you're missing. Get the recipe, here and give it a try.

Jennie Brand-Miller, PhD, FAIFST, FNSA, holds a personal chair in Human Nutrition in the Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders and the School of Molecular Bioscience at the University of Sydney. She is one of the world's leading authorities on the glycemic index.

If you change the habits that cause the signs of pre-diabetes, you can probably avoid ever becoming diabetic.

EXERCISE HELPS TO LOWER HIGH BLOOD SUGAR LEVELS. People who are pre-diabetic have a far more dramatic lowering of high blood sugar and insulin with exercise than non-diabetics (Medicine and Science in Sports and Exercise, December 2011;43(12):2231- 2240). High blood sugar levels cause sugar to stick to the outer surface of cell membranes and destroy them. High blood insulin levels constrict arteries leading to the heart to cause heart attacks.

INTENSE EXERCISE IS FAR MORE EFFECTIVE IN CONTROLLING BLOOD SUGAR LEVELS THAN JUST EXERCISING. In another study, men performed the following workout three times a week: They warmed up by pedaling on a stationary bicycle for five minutes, performed two 20-second hard sprints and then cooled down by pedaling slowly for five minutes (European Journal of Applied Physiology, November 29, 2011). After six weeks, there was an incredible drop in blood sugar and insulin levels, far more than a diabetic achieves by exercising less intensely for more than one hour a day. The authors write: "These sprints break down as much glycogen in two 20-second sprints as moderate endurance exercise would in an hour."

Muscles store sugar inside their cells as glycogen. Emptying muscle cells of glycogen markedly improves the ability of muscle cells to remove sugar from the bloodstream.

BAD HABITS THAT CAUSE DIABETES: If you have type II diabetes, you probably did it to yourself. More than 90 percent of diabetes is caused by inability to respond to insulin. Insulin cannot do its job of driving sugar from the bloodstream into cells until it attaches on special hooks on cell membrane called insulin receptors.

• LACKING MUSCLE.Contracting muscles can remove sugar from the bloodstream without needing insulin. However this effect lasts only during exercise and up to 17 hours afterwards, so you have to exercise every day. Exercise draws sugar into cells without even needing insulin, and exercise makes your body respond better to insulin (Medicine & Science in Sports & Exercise, December 2011;43(12):2231-2240).

SUGAR AND OTHER REFINED CARBOHYDRATES: Eating or drinking sugar and refined carbohydrates (such as bakery products and pastas) raises blood sugar levels the most. A high rise in blood sugar causes sugar to stick to cells. Once there, sugar can never be removed. It eventually is converted to sorbitol that destroys the cell to cause all the horrible side effects of diabetes: blindness, deafness, heart attacks, strokes, dementia, impotence, kidney failure, amputations and so forth.

The Intriguiging New Research on How Metformin Might Be Undermining Exercise

I first heard about this research back in October, and I've mentioned it to everyone I know who takes Metformin. It's paradoxical, disturbing, and demonstrates the complex effects of drug therapy.

Metformin is often the first line of defense for those diagnosed with pre-diabetes or type-2 diabetes. It helps to control blood sugar and improve insulin sensitivity. All good things. RIght?

So it's common sense that if you combine exercise with Metformin, you're going to have a synergistic winning effect. Right? Wrong! Too bad that doesn't seem to happen.

According to two separate studies by researchers at two different universities--the University of Alberta, and the University of Massachusetts at Amherst--Metformin appears to undermine or blunt the beneficial effects of exercise on insulin sensitivity & blood glucose response. Not at all what anyone was expecting to happen.

But, stay tuned. As with all research, more studies are in order. Maybe the timing of one's exercise or the timing of the drug can modify the undermining effect that Metformin has on exercise. It's just too bad that one of the best things that type-2 diabetics can do for themselves--exercise--might be undermined by the prescription drug they are taking.

Here's what seems to be going on when Metformin is combined with exercise.

"Both exercise and the common type 2 diabetes medication Metformin are known to dramatically reduce blood sugar levels in diabetics.

So starting patients on therapies that involve the use of the drug and frequent physical activity has long been supposed to be a valuable tool in fighting high blood sugar.

However, new research published in the journal Diabetes Care indicates that the effects of Metformin and exercise may actually cancel each other [out], potentially leading to even worse blood sugar control in patients with type 2 diabetes.

It is widely believed that Metformin lowers glucose levels by activating exercise-like pathways in the metabolic system. The researchers said that when a person on the medication is physically active, this may result in counter-regulatory reactions that cancel each other out."

According to Barry Braun PhD of the University of Massachusetts, one of researchers involved in the study recently published in Diabetes Care:

"Metformin is known to increase the breakdown of triglycerides to fatty acids, which we did see--and this may interfere with the uptake of glucose from blood [caused by exercise]."

“Metformin reduces glucose in the blood and many believe it does so by activating exercise-like pathways.

As expected, in our study Metformin lowered the blood glucose concentrations measured during a two-hour period after lunch.

But we found that on the non-exercise day Metformin led to better glucose control after lunch than on the day our participants took Metformin and exercised.”

Boulé thinks that because both Metformin and exercise act to lower glucose levels, the combination may have triggered a counter regulatory response by the body to prevent glucose levels dipping too much.

“During exercise, glucagon concentrations increased in the blood (a hormone secreted by the pancreas that raises glucose levels) but when we combined exercise and Metformin the glucagon levels were almost twice as elevated.”

Boule also believes his study was the first to document a significantly increased heart rate when performing aerobic exercise of various intensities with Metformin (six beats per minute on average)--which may also undermine exercise in diabetics.

Dr. Harlan Krumholz of Yale & Dr. Rodney Hayward of Michigan argue for a sea change in treating cholesterol. Treatment based on overall risk, rather than a single LDL number. [I say "Hooray!"] What do you think?

Makes sense to me when you look at the evidence of drastic health & cardiac risk improvements (far better than with statins)--with no adverse effects, for people on the Esselstyn plant-based no-oil diet--even when LDL levels sometimes don't go down as drastically as they might with high-dose statins. You stop making small-dense atherogenic LDL. Looking solely at LDL numbers ignores the reality of "light fluffy LDL).

If inflammation is the main driver of heart disease--this makes sense to this rank amateur. Time to focus on the big picture (weight loss, BP-lowering, diabetes reversal, inflammation-reduction) when it comes to heart disease prevention--not one single lipid number!

In focusing on patient risk, rather than LDL-cholesterol treatment targets, doctors would improve patient outcomes and reduce adverse effects and costs that result from treating low-risk, low-benefit patients, say experts.

If you love your children, stay as healthy as you can, for their sake, if not your own! Heard this on Diane Rehm this morning--and it's worth listening to if you've ever cared for or been responsible for an elderly sick parent or relative. It's only going to get more difficult as our economy & gov't assistance gets more challenging. Many can't afford assisted living or nursing care--and taking care of a sick parent at home (especially if you are working-live out-of-town-or have kids at home) can be one of the most difficult of life's challenges. I was 30 years old with a newborn when my dad suffered a major stroke. It's not easy.

We all hope that we will get the care we need through our old age. But these days, Social Security, Medicare, pensions and retirement plans seem less of a sure thing. Economic uncertainty is putting new pressure on adults to take on...

Exercise, Education, Friends, Volunteer, Stay Calm--the Better Brain Prescription. Must reading if you wonder why some people remain sharper than others as they age.

"When the Midus team (a National Institute of Aging mega-research project studying mid-life) put their data together, they noticed other similarities among people with the strongest cognitive skills. Senior citizens who performed as well as younger adults in fluid intelligence tended to share four characteristics in addition to having a college degree and regularly engaging in mental workouts: they exercised frequently; they were socially active, frequently seeing friends and family, volunteering or attending meetings; they were better at remaining calm in the face of stress; and they felt more in control of their lives.

Just as money and education often run together, these factors tend to reinforce one another. Adults who call on friends and family for support may be better able to reduce their stress, and reducing their stress may give them sense of control. "

Missed it on Facebook? Find it here. A few readers told me they were disappointed that I started posting a lot of information only on Facebook--and not on HHLL. Turns out, if you don't have a Facebook account, it's a...

I take a DHA supplement everyday--along with chia & flax. B-12 is a must. I'm not taking any chances with my "brain nutrients." I will have the opportunity to take a DHA test soon to measure how well my plant-based omega-3s (ALA) are converting into long-chain EPA & DHA. Very curious to find out.

What a revelation! My very first blog post was made on January 10, 2008. How my life has changed since then! No more counting calories, or measuring food. I now eat until my appetite & "heart's content"! I still use My Food Diary for getting the Nutritional Info for my recipes--and to check in every so often to see how much protein, fat, vitamin A, vitamin C, iron, & calcium I'm getting from my typical diet. It always checks out as "Excellent". Happy Blog Anniversary to me! First public post was on January 18, 2008! Some things never change! http://www.happyhealthylonglife.com/happy_healthy_long_life/2008/01/crazy-busy-over.html

I joined MyFoodDiary a couple of years ago when Tarah Parker-Pope recommended it in her review of food diaries for the Wall Street Journal. When I use it, it's eye opening & IT WORKS! It shows you exactly how healthy...

Hands down, one of the best videos I've seen to explain how what we eat affects our health & our weight. Whether your pre-diabetic, already have type-2 diabetes, or you're perfectly healthy--take the 37 minutes to watch this. Best time investment of the week for me. Dr. Barnard is funny, articulate, & turns the complicated into simple!!! Just watch it until the end. And he changed my mind about salmon.

Ray Rice, the leading rusher for the Baltimore Ravens, has a diet secret: mixing in spoonfuls of an obscure Bolivian-grown seed that, he believes, replenishes his energy and helps keep his digestive system humming.

This large study of woman over age 70 found that even very small amounts of protein in their urine indicated the very beginnings of kidney dysfunction, and signaled that cognitive abilities — higher-order brain functions like memory and verbal fluency — declined two to seven times faster than normal. Why? Damage to small blood vessels--in the kidney & the brain. The cause? Vascular inflammation associated with obesity, diabetes, & hypertension. The puzzle pieces continue to fit together. Diet does matter!

Off to work on this Saturday. Packed my lunch box with a Green Smoothie (lacinato kale, Swiss chard, orange, carrots, mixed berries), Crockpot Chocolate Oatmeal with chia, walnuts, & berries, and an OMG! Cajun Kale Soup with just a little Field Roast "Andouile Sausage" & Rice. Recipe on Sunday--if I have time.

Seems like timely news! Could fish oil be on the way out--and sustainable algal oil on the way in? Hmm. Or maybe it will turn out that none of it's needed if you're on a plant-based, no-added-oil, balanced omega-6:omega-3 diet.

Watch this sometime today--without fail!! A Doctor-Professor answers the old question "What is the single best thing we can do for our health" in a completely new way.

Dr. Mike Evans is founder of the Health Design Lab at the Li Ka Shing Knowledge Institute, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a staff physician at St. Michael's Hospital. A big thank you to Scott in MN for sharing this gem with me! I'll present more convincing evidence on Tuesday on HHLL.

Latest HHLL post. My latest new fave soup discovery. Plus some "sure bets" for dinner this week. And how about a couple movie recommendations for a winter stay-at-home "Dinner and a Movie Night"?

The Healthy Librarian's Enlightened Cajun Kale "Spicy Sausage" & Rice Soup I found this recipe hiding in a magazine at my hair salon. On Tuesday I got my hair cut & colored (don't judge!), and while I waited from Michelle...

January 23, 2011

The Natural Standard Database: Strontium Ranelate for Osteoporosis

NPR: The Story SSRI's for Depression--The Low Serotonin Theory

Planet Money on "This American Life": The Euro Crisis & What Really Happened to Greece. Economics Made Interesting & Understandable

Researchers Compare Osteoporosis Drug Effectiveness. Strontium ranelate may be a more efficient osteoporosis drug than alendronate, according to a recent study. Strontium is a metallic element that has properties similar to those of calcium. The body can easily incorporate strontium into bones and tooth enamel. Strontium ranelate is a frequently prescribed drug for post-menopausal osteoporosis that may not only prevent the breakdown of bone, but may also encourage bone growth and density. The scientists concluded that strontium ranelate may have a stronger influence on the structure of the bones than alendronate. However, they added that more evidence is needed in order to better understand these findings.

Everyone likes a simple late 1980's story of a chemical imbalance brought on by low serotonin--to explain depression--and that's why it has remained very popular. "I don't know of any story that has supplanted it," says Alan Frazer, a researcher who studies how antidepressant medications work. He is also chair of the pharmacology department at the University of Texas Health Science Center in San Antonio. Unfortunately, the real story is complicated, and in a way, not all that reassuring. Researchers don't really know what causes depression. They're making progress, but they don't know. That's the real story. It's not exactly a blockbuster.

NPR: The antidepressant Prozac selectively targets the chemical serotonin. When the drug was introduced in the 1980s, it helped solidify the idea in many minds that depression was the result of a chemical imbalance. But the real story is far more complicated.

I heard part of this on the way home from the gym on Sunday--and I'm going back for more! It turns snoozer info into an exciting who-done-it. It clarifies what's going on in Greece, Spain, & Portugal. Get the whole Euro monetary crisis explained in a way that you sure to understand! Viva Planet Money & This American Life. I love Ira Glass.

If you're like us, when the words "European debt crisis" pop up in the news you feel a little worried, and a little like taking a nap. Turns out, there's a story behind this story. One that's filled with guilt, and drama, and betrayal, and 100-year-old dreams come true. Alex Blumberg of Planet Money...

January 24, 2012

Healthy Librarian Tip: Cocoa-PB2 Chocolate Heaven

HHLL Reader's Tip: Ann Esselstyn's Orange Soup Simplified in Crockpot

New York Time Education Issue: One Hour a Day--The Lifetime Learning Prescription

HHLL Post: The Green Smoothie Controversy

The Vegan RD: Dairy/Plant-Based Comparisons--And the Winner is?

New York Times: The Calorie-Burning Benefits of Brown Fat--A Good Reason to Exercise & to Lower Your Thermostat

This morning's genius "no-work" tip from HHLL reader Amy: Just wanted you to know that I got rushed today and put Ann Esselstyn's Orange soup in my crockpot. I did none of the steps AT ALL. I merely put in precut raw butternut squash and raw, peeled, cut up sweet potatoes, chopped onion, chopped celery, chopped carrot, the chopped garlic, the lentils, 1 tsp salt, the rosemary and red pepper. Plus the 8 cups of water. When I came home from work I used my immersion blender to whir it all up and it was amazing. I cannot believe it! Pass it on! :) Recipe below.

Ann Esselstyn's Awesome Almost All-Orange Vegetable Soup Ann Essestyn's Very Easy Blueberry Muffins Click here to go to the web version of this post, if you've received this via email. Better for photos. My apologies for writing another recipe/food post....

Devote 1 single hour a day to learning something new, no matter what--something that's out of your comfort zone. Take advantage of free mini-online classes on iTunes U which includes Stanford & MIT or even YouTube. Keep track of it all in a notebook or a spreadsheet. Jeremy Gleick, you inspire me!

My latest HHLL post! The Green Smoothie Controversy. Is it good for your health? It all depends. My argument for a greens & vegetable heavy smoothie, that's light on the fruit. What's your opinion?

The Healthy Librarian's Vegetable-Heavy Smoothie - Mostly Kale (8 cups), 2 carrots, 1 orange, and 1 cup of berries Yesterday, I received this email from Gael, a long-time HHLL reader: "This does not make me happy!" To Smoothie or Not...

A must read comparison of dairy vs non-dairy equivalents. This research confirms that milk and other dairy products have nothing to offer that you can’t get elsewhere. Here are some things that happened when dairy products were replaced with nondairy foods. The amount of saturated fat and sodium both dropped. And the amounts of vitamin A, potassium, and magnesium all increased. The study didn’t analyze vitamin C, vitamin K, iron or fiber, none of which are found in dairy products and all of which would be provided by the nondairy composite. Thanks to HHLL reader, Betty, for sharing this with me!

My house is set at 58 degrees in the winter. It's freezing at work, too. And I exercise. Gotta love that calorie-burning brown fat. Who knew? I'm not complaining about a too cold house anymore. New article from the Journal of of Clinical Investigation by Dr. Carpentier explains how it works. Brown fat, Dr. Carpentier, “Is on fire.” On average, Dr. Carpentier said, the brown fat burned about 250 calories over three hours. It not only takes up glucose, if you have it, it will keep you warmer in a freezing room.

The New York Times: In separate studies, researchers have determined that in cold conditions, people’s calorie-gobbling brown fat uses ordinary fat as fuel — and that exercise may convert ordinary fat to brown fat.

January 25, 2012

Disease Proof: It's a Junk Food Jungle Out There for the Kiddos--Two Mom's Track the Sugary Snacks Offered to Their Kids for 6 Weeks

Wall Street Journal: Point-Counter Point on Prescribing Statins for Prevention--Should Healthy People Take Statins?

Dr. Michael Greger: The Number One Cancer-Fighting Vegetables

New England Journal of Medicine: Is Heart Disease or a Stroke in Your Future? An Easy Risk Calculator.

In forty-five days, three children, ages 3, 5, and 7 were offered a total of 41,734 extra calories; 1,927 grams of fat; and 6,470 grams of sugar! No joke! No wonder our kids are hooked on sugar & fat. Even if your house is junk food-free, there's always someone else ready to offer them a treat. Interesting experiment.

Drs. Roger Blumenthal & Rita Redberg do an enlightening "Point Counter-Point" in the Wall Street Journal on prescribing statins to healthy people for primary prevention.

Here's what Blumental says: Critics of statins argue that lifestyle changes are a lot cheaper than drugs. But generic statins cost about $50 a year. Can you get a year's worth of fruits and vegetables for $50? (Me: and that's a reason to prescribe drugs?? But, it gets better...when he says:)

What's more, the true alternative to statins is more costly than that. Current lifestyles in the U.S. are flawed. We're getting fatter, older and sicker. We must fundamentally restructure our food supply, so that the focus is not on meat and high-calorie, high-fat foodstuffs with little nutritional value. Our cities, our workday and our pastimes must be restructured to promote physical activity and heart-healthy behaviors.

Roger Blumenthal of Johns Hopkins says statins save lives in seemingly healthy people who have high cholesterol. Rita Redberg of UC San Francisco argues that the evidence isn't clear and that the risk of side effects is too great.

Given the release this month of the American Cancer Society’s new dietary guidelines calling for an “emphasis on plant foods,” I thought for today’s video pick (featured below) I’d feature a video that offers insight into which plant foods may be best. It covers a landmark study that pitted 34 common vegetables against 8 different lines of human cancer cells. Make sure to also check out the “prequel” video Veggies vs. Cancer. Thanks to HHLL reader Gael for sharing this one!

A study in the January 25, 2012 New England Journal of Medicine offers a simple way to predict the risk of a fatal or debilitating heart attack or stroke for a middle-aged person over the rest of his or her life."

If at age 45 you have two or more of either elevated blood pressure, cholesterol, diabetes or smoking, and you're a man, then there's a 50-50 proposition that you will have a heart attack or a stroke during your remaining lifespan," cardiologist Donald Lloyd-Jones, who headed the study at Northwestern University's Feinberg School of Medicine. Women with two risk factors have about a 30 percent chance.

Having even one risk factor dramatically increases the risk of heart disease. And 95 percent of middle-aged Americans (ages 45-55) have at least one risk factor for heart disease.

NPR: Middle-aged men with two common risk factors have a 50-50 chance of having a serious heart attack or stroke as they grow older, a new study finds. The findings suggest that taming risks early in life can make big difference later on.

This just published study (ahead of print) in the American Journal of Clinical Nutrition found that flavonoids have a number of benefits linked to less heart disease & stroke-- including fighting inflammation and acting as antioxidants — which means they also help protect body cells from damage that may lead to chronic diseases and cancer. The findings are based on more than 98,000 men and women Thanks to Bev for sharing this!

According to a new study published in the American Journal of Clinical Nutrition, people who get the most flavonoids in their diets are less likely to die of heart disease or stroke, when compared to those who ate the least flavonoids. The compounds are found in a range of plant foods, including man...

In a new study, researchers studied 559 adolescents between the ages of 14 and 18. They collected data on participants' diet and blood sugar levels. The results suggested that higher fructose consumption may be associated with several heart disease risk factors, including higher blood pressure, higher blood sugar and increased levels of C-reactive protein, a marker of inflammation.

NIH: Women who consumed a diet high in animal fat and cholesterol before pregnancy were at higher risk for gestational diabetes than women whose diets were lower in animal fat and cholesterol, according to researchers at the National Institutes of Health and Harvard University.

At the end of the study, the kettlebell exercisers reported less pain as well as improved strength in the trunk and core muscles, compared with the control group. Over all, working out with kettlebells reduced lower back pain by 57 percent and cut neck and shoulder pain by 46 percent.

New York Times: Kettle-shaped iron weights, which have been used for centuries to train Russian soldiers and athletes, appear to be a promising therapy for back, neck and shoulder pain, new research shows.

January 27, 2012

NPR: StoryCorps on Coping with the Sudden Death of a Child--Overcoming Grief

Every Friday morning I listen to StoryCorps. I am always moved beyond any expectation. Real people sharing their stories. Sometimes inspiring. Sometimes devastating. Always thought-provoking. This morning I cried.

NPR's StoryCorps: Dennis Apple and his wife, Buelah, came to StoryCorps to talk about their son Denny. Nearly 21 years ago, Denny came down with mononucleosis. Before going to bed one night, he took some medicine, and talked about where he wanted to sleep.

Haven't listened to this one yet--but the People's Pharmacy podcasts are my listening favorites for my work commute. Always top-notch experts.

Probably more for the athletes, skinnies, & exercisers among us--with a 1/2 cup of chia & 2 TBS of hemp you're getting 12.25 grams of fat per serving--but lots of it is healthy omega-3s. I've got all the ingredients in my pantry, so I'll give it a try (with Penzey's cocoa). BTW--organic shelled hemp seed is DELICIOUS!

Chia seeds are one of the oldest cultivated plants known to man. They are loaded with antioxidants, essential fatty acids (3 and 6), vitamins, minerals and fiber. Chia seeds maintain blood sugar levels as they slow our bodies conversion of carbohydrates into simple sugars. They are great for an a...

You've got questions, I've got answers!1. My husband has been concerned that we're not getting enough calcium since switching to a vegetarian (trying to be vegan) diet. He's run some numbers to compare what we're eating to see how much we are getting each day, but still feels like we ...

I usually use 1 TBS of flax meal mixed in 3 TBS of water as an egg substitute, but, I wanted more guidance before trying HHLL reader Amy's Black Bean Cake which uses 3 eggs. Would Energ-G be better? Came across this helpful looking post. Verdict: I'm going with "flax eggs".

‎"About twenty years ago, researchers found the missing link. They discovered that colorful plant foods in their natural state were also rich in thousands of compounds with important health properties for humans—phytochemicals. Only by eating an assortment of natural foods...

Hey 20 & 30 somethings--take note! A recent study published in Osteoporosis International investigated the normal exercise routines of more than 1,000 25-year-old women and found that high-impact weight-bearing activities, particularly jogging and spinning (my fave), led to stronger bones than similar low-impact exercises like walking and regular cycling. Researchers believe these differences occur because higher impact exercises involve more jumping and strength-training which place more resistance on the skeleton, better stimulating bone growth.

As obesity continues to plague Americans, exercising for weight loss seems to be at the forefront of education, news, and entertainment. But exercise has benefits far beyond just losing weight, including research supporting its potential to ward off osteoporosis. A recent study in Sweden confirms ...

If you received this post via email, click here to get to the web version with all the links & Dr. Barnard's video.

This is hands down, one of the best videos I've seen to explain how what we eat affects our health & our weight. Whether you're pre-diabetic, already have type-2 diabetes, or you're perfectly healthy--take the 37 minutes to watch this.

Just watch it until the end. And he even changed my mind about salmon.

Highlights from the Healthy Librarian's Notes

I didn't watch this with the intent of posting about it (beyond Facebook)--so I took quick notes. But I learned so much from the video, I couldn't resist posting my notes here.

Here's what captured my attention. Please watch the video for yourself, though--don't just rely on my notes-you'll miss a lot!

Please Note: The video is about Type-2 Diabetes, not Type-1 Diabetes, aka Juvenile Diabetes. They are different diseases.

1. Sure, diabetes means you have too much glucose. But, glucose is good thing. It's not the bad guy. It powers our muscles. It powers our brain. We need glucose.

2. The problem with glucose & diabetes, is that it's not going where it's supposed to go--into the cells that need the glucose--it's circulating around in the blood. And when there's too much glucose circulating in the blood, it can damage our blood vessels--especially the tiny ones--like behind our eyes, in our kidneys, and in our feet--as well as our heart. Diabetes is the leading cause of blindness, kidney, and heart disease.

3. Carbohydrates are not the cause, and have never been the cause of diabetes. If that were the case, then cultures that eat a diet made up of mostly high-fiber whole food carbohydrates would have high rates of diabetes. That's not the case. And when people from these cultures move to a Western country & start eating as we do--their rates of diabetes rise.

6. Why do people lose weight on a vegan no-added oil diet--yet still feel full & satisfied? Simple mathematics. Every gram of fat has 9 calories. Every gram of carbohydrates has 4 calories. If you take fat out of the diet, you lose weight. Note: We're talking about whole grain, high fiber, unprocessed carbohydrates--not white flour or Entemann's Fat-Free Cookies.

7. The Fiber Connection to weight loss--the Fullness Factor: The average American eats about 12 grams of fiber a day and consumes about 2000 calories a day. As soon as you increase your fiber intake with fruits, vegetables, beans, & whole grains--the average person is able to feel full on 200 calories less--1800 calories. Blame that on the fiber.

8. A vegan high-fiber diet has a higher "thermogenic effect" on our metabolism, than the typical Western diet. Huh? Let me try to explain. (But Neal does a better job.) Prior to starting a vegan diet, Barnard measures the oxygen intake of his patients. Turns out, if you're taking in a lot of oxygen, you have a fast metabolism, & burn calories faster. The less oxygen you take in--the slower your metabolism, & the slower the calorie burn. His patients who are eating the typical Western diet are taking in less oxygen--and have slower metabolisms. Yes, what you eat affects the speed of your metabolism. Barnard measures his patients after they eat 2 cans of Boost (that awful "faux" meal in a can)--both pre-vegan diet--and post-vegan diet. After the switch to a vegan diet--his patients had on average, a 20% increase in their "after meal" calorie burn. They had kicked their metabolisms up a notch! Another weight-loss booster.

Why the increase in calorie burn on a vegan diet? The "thermic effect" of food increases on a vegan diet as compared to a Western diet, because the nutrition in the vegan meals is able to enter our cells more efficiently--providing a better calorie burn after every meal. This effect lasts for about 3 hours after each meal.

9. Dr. Barnard's NIH-funded study compared the American Dietetic Association's Diet to the vegan diet for type-2 diabetes. 99 participants. Barnard shares the example of Vance--a 31 year-old diabetic with a long family history of diabetes & diabetic complications. At the start of the study his A1c level was 9 1/2--on the high side.. The average diabetic's A1c level is 8. After going on a vegan diet, Vance's A1c level dropped to 5.3. Within a year he had lost 60 pounds, and his doctor said there was no longer any reason for him to stay on diabetes medications.

10. How Food Can Fight Pain. Barnard shares an example of a diabetic study participant who also had rheumatoid arthritis. After changing to a vegan diet she discovered that she was able to easily open up cans--an impossible task beforehand. According to Barnard, about 1/2 of arthritis sufferers have an identifiable food connection to their disease. It's not 100% for everyone--but, for about half of rheumatoid arthritis sufferers, eliminating dairy & animal protein relieves their pain.

11. "Can I have a little salmon every once in awhile?" Short answer from Barnard? No! Sure it has some good fat--the omega-3s--but it also has some bad fat. All fish is a mixture of good fat and bad fat--and the waistline can store good fat just as well as it can store bad fat. Chinook salmon is 50% fat! I checked--and believe it or not--Barnard's right!

12. What about white meat? Chicken? Turkey? The leanest beef is 29% fat. Chicken is 23% fat. Beans are 4% fat. You run the numbers. According to Barnard, you can't reverse diabetes by going from beef to chicken. Gee, how many people do we all know who think that switching from beef to chicken is the healthy choice? I know I did.

13. If you go on a vegan diet, play it safe & take a multi-vitamin & B-12. (OK--I know there's some controversy about taking multi's, but Barnard is playing it safe.) Vegans need adequate B-12--and there aren't reliable sources of it in the plant world. Taking a B-12 is a very easy fix. You'll already be getting far more of the vitamins & minerals you need by switching to a vegan diet. B-12 is the exception. Eat flax meal or chia daily for omega-3.

14. Don't change your diet immediately. Take a couple of weeks to look over Barnard's meal plan, and explore healthy (no-added oil) plant-based cookbooks before you get started. Planning ahead will make a big difference to your success. You'll be armed with a game plan! Here's the link to his 21-Day Weight-Loss Kick-Start book for some inspiration. Try out some recipes. Get some good recipes under your belt. 6-8 is all you really need to get started.

What if you don't cook? What if you have the "Room-Service" Gene. Barnard has plenty of great suggestions about what to order at Italian, Mexican, fast-food, Japanese, & Indian restaurants. Here's a link to his Kick-Start site, with recipes & meal plans.

15. If you are diabetic & you change your diet--just be aware that you may become hypoglycemic, if you're taking diabetes medication. This is natural--you're blood sugar is decreasing (a good thing)--and if you're taking medication for diabetes, this can happen. He has suggestions to deal with this natural occurence--and of course actively work with your doctor. Listen to the entire video, so you don't miss Barnard's recommendations.

16. Take the Three-Week Challenge. Do it for every meal. Do it everyday. Even if you're invited to a free meal at Outback Steak House---order a plain baked potato & go to the salad bar. There are options. The only way you'll be able to see how well this diet works--and be able to feel what it's like to be on a healthy diet--is to give it 100% for three weeks. No exceptions, or rule-changing.

17. You need three weeks in order for your "tastes" to change. Barnard gives the example of switching from whole milk to skim milk. It's hard to do at first--skim milk tastes so watery. But, once you're used to it--you can't go back. That's how it is when you switch to a vegan diet--and start enjoying plant-based meals. It's hard to go back to cheeseburgers & steak. I wouldn't have believed it either, if I hadn't tried it myself.

18. And, if you find you don't like a vegan diet, you can always go back to the foods that got you sick in the first place. And stay on medications, and test your blood levels for the rest of your life.

19. If plant-based foods aren't for you--consider the transition foods. The faux meats. There are plenty of relatively low-fat options--and the flavors just keep getting better and better. Neal's own father, a former cattle rancher in Fargo, North Dakota, doesn't quite realize he's a vegan--because Neal's mom keeps preparing faux meats--for her meat-loving husband.

20. Barnard's tips: Try different recipes. Do it for 3 weeks. Eat faux if you absolutely must. Think of it as methadone.

21. Annual cost of medications for diabetics is $2000-$5000/a year--for diabetes medications & statins. Now multiply that by the 21 million diabetics in the U.S. And that's just the cost of medications--and doesn't include hospitalizations & complications. Isn't it high time to lower our health care costs?

22. Worry about our kids. Childhood obesity & diabetes are on the rise. As beef & dairy prices fall, our government helps the farmers by buying it up & feeding the surplus to our kids through the school lunch programs. Feeding our kids cheeseburgers & pepperoni pizza, in the end is not the wisest economic decision.

I apologize for these incomplete notes--and for any statements I may have inadvertently written down incorrectly.

I encourage you to watch the video yourself.

It's a 37 minute time investment you will not regret. And besides--Barnard is just plain interesting, as well as funny. It's better than anything you'll find on TV tonight!

January 19, 2012

If you received this via email, click here to get to the web version with all the links, and a video.

Missed it on Facebook? Find it here.

A few readers told me they were disappointed that I started posting a lot of information only on Facebook--and not on HHLL. Turns out, if you don't have a Facebook account, it's a pain to navigate a Facebook page. Facebook keeps asking you to login.

The truth is--it's a lot easier for me to post "hot off the press" information on Facebook, without burdening you with multiple emails.

So...in an effort to not leave anyone out, I decided to see what you all think about a weekly collection of my Facebook posts.

Turns out--it's also a good way for me to refer back to the links, articles, & recipes I've posted--and it also makes them "sort of" searchable via the HHLL google search engine. We'll see how well that works!

I left the comments off--in the interest of space. Too bad--because the conversations are very interesting.

Let me know what you think! Should I collect the posts in a weekly update? Or not?

‎"Cholesterol is a white, waxy substance that is not found in plants --- only in animals. It is an essential component of the membrane that coats all our cells, and it is the basic ingredient of sex hormones. Our bodies need cholesterol, and they manufacture it on their own. We do not need to eat it. But we do, when we consume meat, poultry, fish, and other animal-based foods, such as dairy products and eggs. In doing so, we take on excess amounts of the substance. What's more, eating fat [even as added oil] causes the body itself to manufacture excessive amounts of cholesterol, which explains why vegetetarians who eat oil, butter, cheese, milk, ice cream, glazed doughnuts, and French pastry develop coronary disease despite their avoidance of meat." - Dr. Esselstyn

Dr. Esselstyn on oil

Oil was the LAST thing I removed from my cooking/diet. I couldn't imagine how I could cook without it. Trust me--you DO NOT NEED IT FOR COOKING. It's so easy to "saute" without it. Bonus: no greasy stove or pans! Everyone who learns how to cook without it is surprised how easy it is. Lots of easy substitutes for oil in dressings, too! You will not miss it!

Just to clear any questions up: NO OIL! Not even olive oil, which goes against a lot of other advice out there about so-called good fats. The reality is that oils are extremely low in terms of nutritive value. They contain no fiber, no minerals and are 100% fat calories. And above all they contain saturated fat which immediately injures the endothelial lining of the arteries when eaten. It doesn’t matter whether it’s olive oil, corn oil, or any other kind of oil. You should not consume any oil if you have heart disease. This is so important I have detailed oil in Chapter 10.- Dr. Esselstyn

January 18, 2012

New York Times article discusses the latest New England Journal of Medicine article questioning the value of regular bone density tests.

For years doctors were overly enthusiastic, prescribing it for women whose bone density was lower than normal but not in a danger zone, keeping women on the drug indefinitely.

A new study is asking whether frequent bone density measurements make sense for the majority of older women whose bone density is not close to a danger zone on an initial test.

Study on Exercise Keeping Alzheimer's at bay, especially for those with the APOE-4 gene

Here's the New York Times write-up on the Exercise-Alzheimer's study recently published in the Archives of Neurology. If it sounds familiar, that's because I posted the press release five days ago. Gretchen Reynolds does a good job explaining the details. If any drug had as many benefits as does exercise-everyone would want to take it!

A daily walk or jog could alter the risk of developing Alzheimer's or change the course of the disease if it begins in some people, a new study suggests.

NPR's Workout Song Mix

What's your favorite workout song? NPR has a mix for you to listen to--along with the song list to add to your own iPOD. I've got plenty of favorites--but Meat Loaf's full version of "Paradise" is fantastic in a spinning class! OMG! Tomorrow--4 new studies that will convince you to start exercising--if you aren't already.

What we eat really matters to our immune system--and can change the "environment" of our guts--which strengthens our immune system. Turns out--cruciferous vegetables, like broccoli, Brussels sprouts, cabbage, collards, cauliflower, kale, mustard greens, turnips, and rutabagas all have a unique "chemical" that is beneficial to the gut--Indole-3-carbinol.

This is BIG news! "“You are what you eat.” A couple of recent studies underscore the relevance of this adage to the immune system. New studies by Kiss et al [1] and Li et al [2] show how certain dietary components derived from vegetables (broccoli & Brussels sprouts) interact with intestinal immune receptors and thereby regulate the organogenesis of lymphoid follicles, intestinal immunity, and the microbiota." (yeah, I know, too much information)

Western diets are considered to be risk factors for certain diseases, particularly inflammatory bowel disease (IBD [3] High vegetable intake is thought to protect against ulcerative colitis, whereas a diet rich in certain fats, polyunsaturated fatty acids, and meat is considered to increase the risk of both Crohn's disease and ulcerative colitis. Accordingly, it is possible that dietary components prevent or induce inflammation in the gastrointestinal tract.

Kiss et al. and Li et al., by providing a compelling link between diet and protective immune functions, have opened up a new line of inquiry. The search for foods containing similar immunomodulatory compounds has begun.'

Thanks to Dr. H for alerting me to this N Engl J Med article published last Thursday.

My "Healthy Librarian" friend, Marlene's dream come true! 5 minute recipes, with 5 or less ingredients, that cost less than $5. Click on the photo & see the easy-peasy recipe. Not a new link--but still relevant & very useful! Probably not for the "foodies" among us. Sorry, Jeff.

Examples of some of my favorite simple recipes. Most all of them can be made in about 5 minutes, have less then 5 ingredients and cost much less than 5 dollars. These meals are very low in calorie density and very high in nutrient density so you can eat all you want till you are comfortably full without having to worry about portions size or going hungry. They are all based on my lecture, Calorie Density: How To Eat more, Weigh Less & Live Longer! Enjoy!

I love roasted poblanos & HHLL reader Louisville Mike (a taste-conscious foodie) says this was a hit with his family. He skipped the olive oil when tossing the sweet potatoes, and used a little spray instead. His tip: definitely line the roasting pan with foil--my tip: use non-stick foil. This recipe has it all: Sweet potatoes, poblanos, black beans, corn, & spice. Can't wait to try it.

I've made this dish several times now and love it.Thanks for posting it (found you through tastespotting)the only thing i change is that i put the onions and corn (plus some garlic) in with the potatoes and roast them all together. less of a sharp onion flavor then. and i add all the cilantro in a...

You cannot read a more inspiring story of a health-turnaround from a high cholesterol, obesity, & back pain. Lynne Morrissey is a plant-based & exercise rock star. Thanks to Janice Stanger for posting this! Don't miss it!

Lynne Morrissey is a Facebook friend with an inspiring story of survival against heavy genetic odds. Lynne, who lives near St. Louis, Missouri, just turned 50 and has four adult children. She is sharing her achievements so she can show others to never give up. Health is just a forkful away.

Healthy Girl's Kitchen Farmer's Pie Recipe

I loved this recipe--as did others readers who tried it. It could use more seasoning, though, and Penzey's Salt-Free Forward sprinkled on my individual serving kicked it up a notch!

The New York Times. The Connection of Hearing Loss to Dementia. How Hearing Aids Help!

This is an astonishing finding! Here's how hearing loss can contribute to dementia, rather than the other way around. A good reason to get your hearing checked.

“The brain dedicates a lot of resources to hearing. When the clarity of words is garbled, the brain gets a garbled message. It has to reallocate resources to hear at the expense of other brain functions,” according to Dr. Frank R. Lin of Johns Hopkins.

Thus, the overworked brain may lose “cognitive reserve,” the ability of healthy parts of the brain to take over functions lost by other parts.

This "hidden" disability, currently untreated in about 85 percent of those affected, may be the nation's most damaging sensory handicap.

The Vitamin D & Ulcerative Colitis Connection

Study appearing in Gut. "A leading explanation for this north-south gradient in the risk of ulcerative colitis and Crohn's disease may be differences in exposure to sunlight, or UVB radiation, which is generally greater in southern latitudes," wrote Dr. Hamed Khalili, of Massachusetts General Hospital in Boston, and colleagues.

"UV radiation is the greatest environmental determinant of plasma vitamin D, and there is substantial experimental data supporting a role for vitamin D in the innate immunity and regulation of inflammatory response," they noted.

New York Times - The Downside of Cubicle Offices & Group Decision-Making. Why Quiet & Solitude Promotes Creativity & Our Best Work

If you crave silence & alone time when you work, think, write, or read--you are going to LOVE this essay. I work in a noisy cubicle office--so you can just imagine... Learn why solitude is important to creativity--and why "work by committee" falls flat.

We had Seitan Gyros withTzatziki Sauce for dinner tonight! Amazing. If you haven't tried these yet--you don't know what you're missing! Double the Gyro part of recipe so you'll have some for lunch--sauce doesn't have to be doubled. Leave out the onion!! My BIL didn't & he wished he had.

I LOVE this recipe!! The Tzatziki Sauce makes a great salad dressing, too!

My New Go-To Fave Cookbook--Quick-Fix Vegan, by Robin Robertson "You don't have to be a full-time vegan to love this book. Quick-Fix Vegan is packed with 150 fast and easy recipes for putting delcious, healthy food on the table in...

Do Anti-Perspirants Really Have a Connection to Breast Cancer???? Or Is It Just an Urban Legend?

The association between anti-perspirants & breast cancer always seemed the stuff of urban legend--now a new study in the Journal of Applied Toxicology might be changing that. The possible culprit? Parabens--and maybe aluminum. An easy fix. Check the content of your anti-perspirants, cosmetics, & lotions in the EWG's site: http://www.ewg.org/skindeep/

For every extra 100 milligrams of magnesium a person ate per day, their risk of an ischemic stroke -- the most common kind, typically caused by a blood clot -- fell by nine percent. The median magnesium intake for U.S. men and women included in the analysis was 242 milligrams a day (mg/d). The U.S. recommends men and women over age 31 eat 420 and 320 mg/d of magnesium, respectively.

NEW YORK (Reuters Health) - A fresh look at past research concludes that people who eat lots of greens and other foods rich in magnesium have fewer strokes -- a finding that supports current diet guidelines. But...

New Study in the Physician & Sportsmedicine - Lifelong Exerciser Preserve Their Muscles - Muscle Atrophy as We Age is Not Inevitable.

Exercise, baby! Don't stop--and start if you don't! From a study in The Physician and Sportsmedicine that took detailed measurements of 40 masters athletes between the ages of 40 and 81, and found a surprising lack of age-related muscle loss: This study contradicts the common observation that muscle mass and strength decline as a function of aging alone. Instead, these declines may signal the effect of chronic disuse rather than muscle aging. Thanks Janet for the link! I was actually planning to write about this one & 2 other pro-exercise articles, today. But, I was spinning & yoga--ing.

How to Find Real Food at the Supermarket

Another gem from my Healthy Librarian colleague, Marlene! Hilarious!

I'm going to try this one tomorrow--minus the oil. This is one of Robin Robertson's recipes--One of my faves--author of "Quick-Fix Vegan"--so it's got to be good. Thanks to Lani for forwarding this to me.

I highly recommend this dish. It's so easy, so tasty, so pretty to look at, and so nutritious. Just vegetables & beans--that taste like restaurant fare.

If adding more vegetables to your diet is one of your resolutions for a new year, here’s a delicious way to do it. Cut up a few different vegetables (the more the merrier) and roast them until tender, then top with a luscious and protein-rich cannellini bean sauce.

Big news from the esteemed Fred Hutchinson Cancer Center: "This finding is important and clinically useful since C-reactive protein is associated with an increased risk for many cancers as well as cardiovascular disease," said lead author Marian Neuhouser, Ph.D., R.D., a member of the Cancer Prevention Program in the Public Health Sciences Division at the Hutchinson Center. "Lowering inflammatory factors is important for reducing a broad range of health risks. Showing that a low-glycemic-load diet can improve health is important for the millions of Americans who are overweight or obese."

Among overweight and obese adults, a diet rich in slowly digested carbohydrates, such as whole grains, legumes and other high-fiber foods, significantly reduces markers of inflammation associated with chronic disease, according to a new study. Such a "low-glycemic-load" diet, which does not cause bl...

January 13, 2012

Just Heard. Paula Deen Has Type-2 Diabetes. It's rumored she also has a hefty drug company contract. True or False?

The diabetes diagnosis part is true. The Novartis spokesperson part probably isn't. Deen was rumored to be a new spokesperson for the Novartis diabetes drug, but now the Atlantic wire is nixing the rumor. We'll have to wait & see. Here's New York Grub Street's story: "Deen made a mountain of money peddling her butter-soaked food, and now she's poised to make millions more with a "rumored" deal with Novartis as a spokesperson." Thanks Babs for sharing the story.

Exercise Can Fight the Genetic Risk of Alzheimer's

Off to the gym!!! Dr. Robert Green's (study author) BOTTOM LINE:

“As we get older, there are an awful lot of things that influence brain health. The way I think of it is that if you’ve got a disease that’s slowly brewing in your brain and you keep yourself as healthy as possible, and you keep the vascular load on top of that disease — the stuff gumming up the arteries in your brain — if you can keep that to a minimum, then with whatever genetic load you have, and whatever underlying developing disease you have, you do better.” This research confirms many others over the past few years! Eat plant-based heart & brain healthy & exercise. They both boost nitric oxide.

We loved this so much I decided to post my variation. Make it this weekend!

Indian Chili - Daily Garnish's Recipe, Tweaked by the Healthy Librarian I have no business posting a recipe before I head out of the house this morning--then on to the gym, then on to work, & then on to a...

January 11, 2012

The New York Times. What's a Vegetarian Living in Midwest Meat Country to Do?

Great read! There are zero full veg restaurants in my hometown. The upside? You don't often eat in restaurants & you get real good at trying out amazng new recipes. But I do envy New Yorkers, big time!! What's it like where you live?

Nissen's eye-opening talk on intravasclar ultrasound, atherosclerosis, and reversing heart disease with high-dose statins didn't spend too much time discussing diet or lifestyle changes. But it certainly convinced me that I was on the right path--to keep on eating a plant-based no-added-oil diet, and to keep on exercising.

Why? Because, the inarguable evidence we now have from intravascular ultrasound (IVUS) demonstrates how very low LDL levels can absolutely make a difference in stopping the progression of atherosclerosis--ultimately reversing it.

Nissen, who is the chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic, is one of the top & most respected cardiologists in the country. When reporters want an opinion about anything related to heart disease, he is the go-to expert.

What he has to say--and what his power points demonstrate--will convince you that our diet & lifestyle is highly atherogenic--that most of us already have coronary (and/or cerebrovascular) atherosclerosis--in spite of the fact that the majority of us would probably pass a stress test or have normal angiograms.

68% of men & 42% of women who have myocardial infarctions will have less than a 50% stenosis (narrowing) in their coronary arteries--and have no prior symptoms, until an atherosclerotic plaque ruptures from within their arterial wall. To understand how this can happen, click here.

Intravascular ultrasound (IVUS), is a diagnostic technique that's able to measure the arterial plaque withinthe arterial wall, as well as the opening (lumen) of the artery. It's used primarily in clinical studies, not for "regular" patients--because it's costly, time-consuming--and involves risk. But, it has completely changed our understanding of how coronary artery disease occurs--and more importantly, how its progression can be stopped, reversed, and prevented.

Cardiovascular disease (as well as carotid & renal vascular disease) is NOT a disease caused by the narrowing of the arteries.

The opening (lumen) of an artery can even look perfectly normal--because this isn't a disease of the lumen--it's a disease of the vessel wall--and angiograms & stress tests cannot pick up what's going on inside the artery's wall. It's all about that ever-present atherosclerotic plaque embedded inside of our vessel walls.

I'll say it again! Over half of the time this "Tim-Russert-kind-of-disease" of the vascular wall will not show up on a stress test or be seen on an angiogram--and often it won't cause angina or any other symptoms. Your cholesterol numbers might even be in the normal or high normal range--not high enough to warrant more than a low or medium dose of statins.

With standard diagnostic tools you won't have a clue about what's going on inside of your blood vessels. And besides, if you don't have angina or serious symptoms--you're never going to have a diagnostic test, anyway.

Stents & bypasses won't stop the disease--they'll just get you out of a crisis. And the typical normal dose of statins can only reduce cardiovascular disease by one-third.

How did we get into this mess? Blame can be placed squarely on our diet and lifestyle.

Sorry that the video of Dr. Nissen's lecture is no longer available. If it were, I'm certain you would come to one of three conclusions:

You'll want to take the highest dose of statins your body can tolerate in order to prevent heart disease or stroke--which isn't going to be an easy thing to do, because no physician would likely prescribe such a high-dose of statins just for primary prevention. And evidence continues to mount of increased side effects the higher the dosage, the longer one is on statins, & the older one's age.

You'll just give up thinking about all this prevention, plaque, heart disease & stroke stuff--eat whatever you want to eat, take what the doc prescribes, and let the chips fall where they may. You'll probably end up with some level of heart disease, peripheral artery disease, vascular dementia, or renal artery disease, because the cure seems worse than the disease.

You'll decide to change your diet from one that's atherogenic & slowly killing you, to one that's plant-based-with-no-added oil, because it will do exactly what the highest doses of statins will do without the side effects.

If by now I've convinced you to listen to what Dr. Steven Nissen has to say, just click here, and plan on spending one hour learning something that many physicians might not be aware of. And please get back to me--let me know what you think, and what you plan to do about it. You all know what I've decided to do!

Protecting the Brain & the Soul. Unplugging with a Shot of Nature

Son #2 doesn't spend much time surfing the net--and he rarely forwards articles.

Last May five neuroscientists headed into a remote canyon region of southern Utah for a rafting trip and some hands-on evidence-based brain research--on themselves. They wanted to find out what happens to your brain when you completely unplug from the world. No phones, no computers, no watches, no devices of any kind.

What the wanted to find out first-hand: Would you notice any changes to your brain or thought processes if you could immerse yourself in nature, really disconnecting from distractions, technology, constant interruptions, and your work, of course.

Would your focus and attention improve & sharpen without the usual distractions?

Would thoughts deepen, if noise & interruptions could disappear?

Is nature & silence restorative?

Or would you just feel even more anxious if you're cut off from your work, your techno gadgets--and your everyday world?

Starting out, two of the group were believers in the value of escaping into nature--unplugging--and resting the brain. The other three were skeptics--joined at the hip to their digital devices--and doubtful that the trip would affect them personally or scientifically.

"It was a primitive trip with a sophisticated goal: to understand how heavy use of digital devices and other technology changes how we think and behave, and how a retreat into nature might reverse those effects.

It is a trip into the heart of silence--increasingly rare now that people can get online even in far-flung vacation spots.

By extension, some scientists believe heavy multi-tasking fatigues the brain, draining it of the ability to focus.

As they head down the tight curves the San Juan has carved from ancient sandstone, the travelers will, not surprisingly, unwind, sleep better and lose the nagging feeling to check for a phone in the pocket.

[Dr.] David Strayer, the trip's organizer, a psychology professor at the University of Utah, says that studying what happens when we step away from our devices and rest our brains--in particular, how attention, memory, and learning are affected--is important science.

"Attention is the holy grail," says Strayer.

"Everything that you're conscious of, everything you let in, everything you remember and you forget, depends on it."

[Just the expectation of email or receiving new information seems to be taking up our working memory.]

Working memory is a precious resource in the brain. The scientists hypothesize that a fraction of brain power is tied up in anticipating email and other new information...

"To the extent you have less working memory, you have less space for storing and integrating ideas and therefore, less to do the reasoning you need to do," says [Dr.] Arthur Kramer of the University of Illinois.

"There's a real mental freedom in knowing no one or nothing can interrupt you," says [Dr.] Todd Braver of Washington University.

When he gets back to St. Louis, Braver plans to focus more on understanding what happens to the brain as it rests. He wants to use imaging technology to see whether the effect of nature on the brain can be measured and whether there are the other ways to reproduce it, say through meditation.

On Wednesday I'm starting out on my own journey that will disconnect me from my computer and cellphone.

Neither will get plugged back in until almost mid-June.

It's not exactly a backpacking trip or a silent meditation retreat--but I'll be visiting far-flung places. The first leg starts with a 20 hour road trip to celebrate & attend son #2's graduation--and then my husband & I will embark on multi-leg journey that's a pre-celebration of our 40th anniversary.

As soon as we return home, three of our favorite houseguests will have already arrived at our house--our #1 grandson, son #1, and daughter-in-law #1. Oops--I better thoroughly clean the house & get the bedrooms ready before I leave.

So...I've made the executive decision to leave my computer, my phone, and my blog behind for 3+ weeks and enjoy every moment of this wonderful month with my full attention--minus any distraction.

Learning to Let Go of "Crazy Busy"

I'm great at making myself crazy when I think I have too much to do.

You know what I mean. All that planning in your head that goes into preparing for a long trip. I'm not a "just show up & fly by the seat-of-my-pants kind of gal". I wish I was.

I'm the worst combo: a procrastinator who is also an "over-preparer"--who doesn't want to miss out on anything. Ugh! Turning easy into complicated is not a good thing--but I'm so good at it! I think too much--and then try to do it all at the last minute.

Researching the destinations--planning what I'm going to see & how to get there.

Buying the luggage (the old ones are too heavy), the comfortable walking shoes, the bathing suit (the old one is now too big), figuring out what to pack for every possible circumstance, the foreign currency, and all those little details necessary for travel

Planning a celebration-graduation-Friday-night dinner for son #2--Thanks to Eli, this one's going to be easy and amazing!

Fitting in all the pre-trip chores into my all-ready jammed-packed schedule

While also planning summer visits to North Carolina, Chautauqua, Boston, a family trip to Kentucky, and a July wedding shower. It's going to be a very busy summer! OK, I admit it--these all turned out to be easy-to-plan-events and I had plenty of help from others. It was just the "thinking about them"--and the procrastinating that made them seem so much harder than they were--and drove me crazy.

So it was perfect timing as I tried to fit in one last "before I leave" blog post that thoughts of Norman Fischer serendipitously flew into my head. Really.

I reread (and you can, too!) my October 25, 2008 Norman Fischer post about how to calm down when you think your too darn busy. And honestly, it worked.

So here's the serendipity part. I always have things I want to write about--too many. The problem is, it takes a lot of time to put thoughts to paper (or rather--to computer) and frankly, I've got lots of other stuff to do today. Like plant flower bulbs, put away my laundry, call my aunt, go for a walk, bake cookies for the new neighbors and hang-out with my husband. I've been mulling over writing posts on multi-tasking; strategies from positive psychology to get through tough economic times; yoga as medicine; and lessons from cultures with lots of centenarians & so on.

So, to continue. I get to the Norman Fischer link. It takes me to his newsletter where I learned that Norman not only has a new book out: Sailing Home, but he wrote an article in the September 2008 issue of O Magazine (as in Oprah), called "Simple Yet Astounding Ways to Calm Down".

As with everything related to Norman, the article is wise, kind, thoughtful, and easy to read.

Forget about reading anything I have to say about multi-tasking, getting through tough times, yoga & longevity. Read Norman's article! It's all right there.

And by the way, even though Norman advises against giving advice to grown-up kids, in this case I disagree. So, Son #1, Son #2, Daughter-in-law #1, if you are reading this, I know you guys are crazy busy. I hope you have a chance to read Norman! It will serve you well.

"If you're so crazed that you have to pencil in time for a deep breath, here's how to become more relaxed—and efficient—in less than a minute. All together now: Ahhhhh…

You keep a to-do list, but you can't get through it by the end of the day, and you're frustrated because you feel like you haven't been able to get enough done. You find that things take longer than you thought they would. And when people ask how you are, "Fine" has been replaced by "Too busy."

Welcome to the "too busy" club.

In this technology-driven world, we can do more, so we do—and we love it. We feel effective and powerful as we check items off our lists and use our cell phones, BlackBerrys, and computers, sometimes all at once. We're multitasking, doing as much as we can in the least amount of time. We're active, creative, and engaged! In demand! Being too busy makes us feel as though we're making an impact.

On the other hand, feeling too busy drives us crazy. Falling ever further behind as the to-do list relentlessly grows (each item generating many more items almost as fast as we can think of them) is nerve-racking and stressful. We begin to feel like prisoners of the list, prisoners of our lives and our desires, prisoners of time. There just aren't enough hours in the day. It's as if we're doing battle with time—and losing.

But the point is not how many things we have done or will do in a given amount of time; the point is how we do what we do. If we're rushed and frantic, we're too busy. If we move through our tasks with equanimity, patient and composed, we're not.

In the Zen Buddhist tradition that I've been practicing for many years, there's a story that illustrates this point: A monk is sweeping the temple grounds. Another monk comes by and says, "Too busy!" The first monk replies, "You should know there is one who is not too busy."

Our sweeping monk may have been moving quickly, and so he looked "too busy" to his brother monk. But inside—in his mind—he wasn't busy. In the midst of his vigorous activity, he was in touch with "the one who is not busy."

Most of us judge how busy we are by how much we have to do. When there are too many things to do, we think we're busy, and when there isn't much to do, it feels like we're not busy at all. But in fact, we can feel busy when there isn't that much to do, and we can feel relaxed even when there's a lot going on. The states of "busy" and "not busy" aren't defined by how many things there are to do. Contrary to popular opinion, there is no such thing as multitasking; the brain can tend to only one thing at a time. Being too busy or not being busy is an interpretation of our activity. Busy-ness is a state of mind, not a fact. No matter how much or how little we're doing, we're always just doing what we're doing, simply living this one moment of our lives.

That moment may seem long or short. Time is an internal, not external, reality. Have you noticed that half an hour in the dentist's chair lasts longer than half an hour at a fun dinner party with friends? And five minutes waiting on hold on the phone passes more slowly than five minutes watching a movie. Time is how we live it, not what's measured by the clock (after all, the watch was invented fairly recently, in the 16th century). To be sure, our world operates on clock time, which is convenient and necessary; how else would we make it to that dentist's appointment or dinner party? But the clock is supposed to be working for us, not the other way around. If we feel too busy, we've mistaken a feeling for an objective reality and are held captive to that reality. It needn't be that way.

Okay, you say, good theory: We think we're busy, but we're not—we're just doing one thing after another. But the habit of being convinced we're too busy is hard to shake. What can we do about this persistent mania of feeling task- and time-driven? Understanding something differently is only a beginning. To change the way we live, we have to practice what we've come to understand until it becomes a natural part of us, a habit of thought, feeling, and body. There are many simple techniques that can help us with this. Take three conscious breaths (try it now, as you're reading). This will change your mind. Whatever you're feeling will become less compulsive, less driven. There's a measure of detachment and equanimity even after the first breath. You become more present to your surroundings, to the basic awareness of being alive. Try it the next time you're feeling overwhelmed; it doesn't take much time, and it will help you remember "the one who is not busy," the part of you that's always right there, even when it looks or feels like you're too busy.

Walking meditation—intentionally bringing awareness to your body as you move—can lift you out of a busy-ness-induced, semiconscious funk. If you can become conscious of the way you're moving and the sensation of each movement, you'll feel refreshed instead of rushed. I know what you're thinking: "I'm too busy to go for a walk." But this is something you can do on your way to and from the bathroom. (And if you're really feeling busy, you're probably overdue for a trip there anyway.)

Sometimes just a phrase can help: "Not busy." Remembering our two monks, you can say this softly to yourself when you feel overwhelmed. I do this when I feel crazed; with the repetition of the words, I immediately recognize that it is my feelings and my thoughts that make me feel pressured, not the tasks I have to do. They will get done—or not, and the world and I will survive. Even if I do have a crucial deadline, I'll have a much better chance of making it if I feel "not busy" and can proceed with a calm mind. Feeling frantic doesn't make me more efficient. Quite the contrary, it makes mistakes and glitches more likely.

It goes without saying that if you've bitten off more than you can chew in a day, or in a lifetime, you'd better step back and change your circumstances, if at all possible. Let go of a few activities: Peace of mind is more important, and healthier, than those few extra accomplishments. But if you can't or don't want to change your circumstances, you need to find the most serene and beautiful way to live the life you have.

In the end, if you persistently and unpleasantly feel too busy, remember this: It's not a fact; it's a choice. There is one who is not busy. That one is you."

And the HPLC diet doubles the nonesterified fatty acids (NEFAs) which promote inflammation & atherosclerosis. If you think high-protein-low-carb is good--think again!

And it's all about what's going on inside of the arteries--not just the lipid numbers! A low-fat high-unrefined-carbohydrate diet increases those endothelial progenitator cells--and keeps the artery walls healthy, flexible, and atherosclerosis-resistant. Read more in the PNAS "Vascular effects of a low-carbohydrate high-protein diet"

If you received this post via email, click here to get to the web version with all the links.

What a week this has been! I've had a chance to hear Dr. Dean Ornish (twice), Dr. David Katz of Yale, Dr. Ezekiel Emanuel of NIH, and Dr. Joshual Sharfstein. All national healthcare experts--all saying the same thing--in four different ways:

Change Your Lifestyle & Change Your Health.

Our Western diet is killing us and our children.

This younger generation will likely be the first generation to not live as long as their parents.

93% of diabetes, 81% of heart disease, and 60% of cancer could vanish with diet, exercise, weight loss, smoking cessation.

When the Cleveland Clinic, the top hospital for cardiac care in the U.S., invites Dr. Dean Ornish to speak about reversing heart disease, diabetes, hypertension, and prostate cancer with low-tech lifestyle changes--you know that the no-oil plant-based Esselstyn-style diet is getting closer to going mainstream!

And on May 11, Dr. Caldwell Esselstyn, Jr. is also scheduled to speak at the Cleveland Clinic Wellness Grand Rounds! That comes right after his April 27th (this Wednesday) appearance on Dr. Oz's Show along with Dr. T. Colin Campbell and Dr. Neal Barnard. Click here for more info.

Looks like plant-based & low-fat is starting to seem commonplace these days. Dr. Neal Barnard--another plant-based disease-reversal pioneer--is currently speaking around the country, promoting his latest science-based book, too. Definitely one that I recommend. Wendy, at Healthy Girl's Kitchen heard him speak on Tuesday night and she does a terrific job of summarizing his lecture. Part l and Part II. Thank you, Wendy!

And don't forget that Forks Over Knives premiers in theaters on May 6, 2011. Click here for the schedule, and here for my review.

Sorry for the "non-commercial" interruption--now back to the post: Since most of you didn't have the chance to attend Dr. Ornish's lecture--here's what you would have heard....

He's got the data and the high-tech measurements to back up his claims that a very low-fat vegetarian diet, along with exercise, stress reduction (meditation/yoga), & social support really work--and their effects are synergistic & additive.

The lecture hall was filled with health professionals & support staff.

Ornish Goes Mainstream with Medicare. Could this be a game-changer?

In August 2010, Medicare approved both the Ornish & Pritikin comprehensive lifestyle disease-reversal programs for reimbursement. As Ornish says, "If we can change reimbursement--we'll change the practice of medicine!" Reimbursement to prevent chronic diseases? Money well-spent.

So What Is the Ornish Approach?

Participants in Ornish's clinical trials always followed a very low-fat, vegetarian diet, closely bordering on vegan. That's what reversed their heart disease, type 2 diabetes, hypertension, and early prostate cancer. But he carefully side-stepped discussing the diet specifics in this lecture.

Maybe he was mum about the details of his diet because these days he doesn't want to scare people away by demanding that they follow a super strict low-fat vegetarian diet. And, he hates the word DIET!

Lately, he's offering more of a Spectrum of food choices--you choose how strict you want your diet to be--based on your health and your risk factors. To get the details, I had to go to his website. Click here

Here's the deal. When it comes to reversing heart disease--even Ornish says, you need to go mostly plant-based & very low fat. If you're healthy--and without risk factors or excess weight, you can be a little more indulgent.

But wait a second. I've read the research studies. I've heard Dr. Esselstyn speak. I've heard Dr. Steven Nissen speak--the head of Cardiovascular Medicine at the Cleveland Clinic. If you're eating a typical Western diet--you either have heart disease or you're on the way to getting it! Who's left?

Ornish Food Plan to Reverse Heart Disease

Fat--No more than 10% of calories are from fat. This is achieved by not adding any fats, oils, seeds, nuts, avocados, coconut and olives to a mostly plant-based diet. The 10% of calories from fat comes from fat that occurs naturally in grains, vegetables, fruit, beans, legumes and soy foods.

Cholesterol-- No more than 10 milligrams of cholesterol per day. To meet this goal, non-fat dairy products are limited to 2 servings per day. Non-fat dairy products are optional. Soy products can be used instead of dairy products because they are cholesterol free.

Primarily Plant-Based--no meat, poultry, fish, or products made from these foods. Non-fat dairy foods (no more than 2 servings/day) and egg whites are included.

Calories--Unrestricted unless weight loss is desired. Small frequent meals spread throughout the day help avoid hunger and keep energy levels constant. Portion control will assist in reaching and maintaining a healthy body weight and controlling blood sugar levels.

Sugar--Permitted in moderation. No more than 2 servings/day including non-fat sweets. A serving is equivalent to 1 tablespoon or 12 grams of sugar.

Ornish's Spectrum of Food Choices

Heart Disease Reversal Sticks to the Bottom 2 Levels

Ornish's Spectrum Diet is based on one's health, genetics, and risk factors. If you've got risk factors or health problems--you're on the strictest plan. Young & healthy--he's a little more lenient.

"The Spectrum has no rules, no forbidden foods, no guilt -- just a blueprint for determining where you fall on the continuum, and encouragement to make healthful changes.

What matters most is your overall way of eating. I am not saying that you should never consume foods from Group 5-the top of the pyramid (unless you have a serious health condition). If you indulge yourself one day by eating foods from Group 4 or 5, spend a little more time in Groups 1 and 2 the next day.

If you get on a diet, chances are you’ll get off a diet. Sooner or later. For most people, being on a diet—any diet—is not sustainable."

But the further you move toward the healthier end, the more likely you are to look and feel better.

Look, I understand Ornish's soft-pedal approach--but, I prefer the Esselstyn's "Just Stick to the Program 100%" approach. Why fool around with half measures? Give me too much leeway--and I'm sliding down that slippery slope!

If you commit yourself to just follow the program (Esselstyn or Ornish) 100% for one month--you'll lose weight, you'll feel great, your energy will improve, and you'll be motivated to continue. With half-measures you just aren't going to see the same results!

Diet: mostly vegetarian, no added oil, no nuts, no-fat dairy & egg whites are allowed, whole grains, fruit, vegetables, beans & legumes. But, Ornish, also offers a Spectrum (as his book is called) of choices for people who are healthy, or aren't quite ready to follow a super strict diet--including small amounts of "safe" fish, like wild salmon.

Exercise: at least thirty minutes a day--but Ornish will forgive you if you skip a day or do less. Click here for details.

Meditation/Stress reduction Click here for program details. Don't have 20 minutes to meditate? Try it for 5 minutes.

The Importance of Social networks/close relationships: depression & loneliness impair health. Group support is needed to sustain lifestyle changes. Click here for details.

In Ornish's experience, all these elements are key to preventing & reversing disease. The body has a remarkable power to heal itself with diet and exercise, but stress, depression, and loneliness all have powerful negative effects on health. Depression increases mortality by 3 to 10 times.

The Fear Factor Fails - What Motivates Us to Change?

Ornish's viewpoint: No one makes long-lasting lifestyle changes based on the fear of a future disease. That's why he says only 30-40% of people stay on statins. But, what about me? Fear worked for me. I made major lifestyle changes after seeing my parents suffering after ischemic strokes.

According to Ornish, no one is thrilled to stay on statins, diabetes or blood pressure meds for the rest of their lives--in the hopes that they'll avoid a future heart attack or stroke. And let's face it, these drugs usually don't do a thing to make us feel better, look better, feel happier, or lose weight. And all drugs come with side effects.

Ornish's favorite cartoon is of men madly mopping up a wet floor without bothering to turn off the running faucet that's making the sink overflow. Change your diet, start to exercise, find a way to reduce stress--and it's like turning off the faucet--actually treating the causes of disease.

After 34 years in the diet-exercise-meditation-disease-reversal business, Ornish has figured out what motivates people to make serious lifestyle changes. He knows that information alone isn't sufficient to get people to change.

Joy (from feeling healthy), freedom (to choose the changes), & pleasure (from real food & good health) are the real hooks that get people to make changes--and to continue on with them.

No one wants to give up something they like (cheeseburgers & ice-cream)--if there's no pay back--and if it doesn't come quickly!

It's only when you start to see positive changes in your body, like weight loss, energy, reduced pain, less stress, and you're able to cut your meds--that you realize your health is in your own hands. Just ask these folks who are following Dr. Esselstyn's diet, or my friend Neal.

Benefits of Meditation. Within 8 weeks of starting to meditate, stress is reduced, cortisol levels drop (the stress hormone), pain lessens, nitric oxide increases (you heard right), the genes responsible for stress & aging are down-regulated, and oxidative stress is also reduced. Stay tuned for an upcoming post on the benefits of meditation.

How You Look. Your skin improves because a plant-based diet along with exercise increases blood flow & slows aging.

Heart Health. As the heart gets more blood--heart disease is reduced--perfusion improves.

It's All Good. You feel better, you look better, you think better, your energy improves---and because you see change quickly--you're motivated to continue. Convinced?

So how hard is it to make these lifestyle big changes?

Here's how Ornish explains it. He asked the lecture hall audience a couple of questions.

"How many of you have one child?" Lots of hands go up.

"Did your life change?" Lots of nods & chuckles.

"And how many of you had a second one?" Lots of hands go up.

"Did you forget how much your life changed?" Lots of laughter.

You can change your lifestyle, and it will bring joy & pleasure. You do get used to it! I did.

Our palates are malleable. Notice how people easily change from drinking whole milk to skim milk to almond/soy/rice milk? And if you grow up eating healthy foods, you prefer them.

Just Show Me the Evidence

I'm all about the research data. Did I hear anything new from Dr. Ornish? Not really--and if you're a long-time blog reader you've already heard most of this. But, it still motivates & inspires me to to hear it again. It helps me to stay the course!

One Patient's Experience--one year after starting the Ornish program

Dr. Ornish assured us that this man's experience wasn't anything exceptional--but the norm.

Ornish recruited 30 men with low-risk prostate cancer tumors, and for 3 months put them on a low-fat (10%) plant-based diet, had them exercise for 30 minutes a day--6 days a week, and participate in stress management sessions with yoga, stretching, and meditation for 60 minutes a day.

Before the intervention, their cancer genes are red--three months later, the cancer genes are turned off, and show green. The men literally "turned off" the RAS family of genes--these are the ones that promote the growth of breast, colon and prostate cancer.

Yes, they turned off cancer genes with lifestyle changes.

And it gets even better--the also "turned on" the GSTM-1 genes--the protein-producing genes that cause breast, colon, and prostate cancer cells to commit suicide.

They turned off the genes that promote cancer--and turned on the genes that promote its death.

70% of cancer tumor progression was stopped or reversed in the group who followed a plant-based diet, exercised, & meditated or practiced yoga for stress relief.

PSAs were reduced

Dose-response relationship--the men who were the most compliant achieved the most beneficial effects.

30% increase in telomere length--a measure of longevity. After only 3 months, 24 out of 30 men showed significant increases in their telomerase levels. Click here to read about the study. No drug is able to achieve this effect. (my note: omega-3s however, do! click here)

Ornish now recommends fish oil--4 grams/a day or the equivalent--a new addition to his plan. He thinks fish oil is better than eating fish, because right now there are no "safe" fish, and when the oil is removed, it can be molecularly distilled to remove any mercury or PCBs. If you do eat fish--choose wild salmon.

Organic produce is better

Reduce fat. Total fat does matter. It promotes inflammation and atherosclerosis. For heart disease reversal, limit fat to 10% or less of calories.

Reduce sugar & refined carbohydrates

Increase fiber--it will fill you up. Move from bad carbohydrates to the good carbohydrates to prevent chronic insulin surges. Refined carbs accelerate the conversion of calories into fat & promote chronic inflammation.

Forget about olive oil! And by the way--the Lyon Study used canola oil--not olive oil--and that's the study everyone cites to promote the benefits of olive oil. They used canola because they couldn't disguise the taste of olive oil. Read more about the negatives of olive oil here.

Reduce sodium.

According to Ornish, although there have been multiple studies on the health benefits of nuts--whether or not they are beneficial for heart patients will require more study!

When it comes to calcium, there's a balance between intake & excretion. Too much animal protein causes calcium excretion.

Angioplasties & bypasses don't prolong life--diet does. They will get you out of a crisis or stop angina. Read the COURAGE Trial results here.

The Ornish Program Approved for Medicare in August 2010

Getting Medicare approval for any new program, procedure, or diagnostic tool is tough. It took Ornish 7 years to finally get approval for his program.

Bottom Line: Ornish's program saves money! On average, his patients lose 20 pounds, improve their quality of life, get their blood pressure back to normal without drugs, lower their cholesterol, and get off of diabetes medications--while helping to prevent future coronary events.

According to Ornish, getting Medicare on board with prevention & reimbursing for lifestyle changes is a major step in changing the practice of medicine.

January 24, 2011

The background: My friend Neal started on Dr. Esselstyn's plant-based no-oil diet six months ago. He attended the day long session that Dr. Esselstyn runs along with his wife Ann, once a month at the Cleveland Clinic. Neal's own physician followed up with all the lab work, and has adjusted his medications accordingly.

Neal is now off all of the hypertension medications he'd been on for at least 10 years. His Lipitor has been cut in half--and his physician figures that will be dropped eventually, too. He's weight is now perfect. His lab tests are enviable.

His local pharmacist knows him pretty well--he's been a regular customer for years.

So, yesterday, when he stopped by the pharmacy, with discretion & hesitancy, the pharmacist asked if he wouldn't mind answering a question or two.

The pharmacist: "Neal, I've noticed that you're no longer taking most of the medications that you've been on for years. I just have to tell you---you're looking absolutely fantastic! Honestly, you look 10 years younger. If you don't mind my asking, what exactly are you doing differently? I really want to know.

The Rest of the Story: My husband joined me this morning for my usual Sunday morning spin class--so it was the first time he'd seen Neal in months.

As we drove home from the gym I started to tell him the story about Neal & his pharmacist. But, before I had gotten even four words out, he immediately interrupted me.

Here's what he said, "I've got to tell you, Neal looks fantastic. Honestly, he looks like a completely different person--like he's at least ten years younger--like a kid. He must be feeling so healthy."

And then I told him what Neal's pharmacist had to say!

Vegetables for Beautiful Skin?

And then there's Neal's wife. She's now eating just like Neal.

I couldn't help but notice how great she looks, as well. Her skin in down-right rosy & glowing. And I'm talking--no make-up--early morning.

When I mentioned this to her, she said: "Funny you should say that. You know, since I started eating this way this past summer, I've stopped taking the skin medication my dermatologist had prescribed. No need anymore."

Coincidently, 10 days ago son #2 emailed me an article from Time Magazine, that proves the point. He wrote, "Nothing you didn't already know, but looks like more people are catching on."

From left: suntanned, neutral, with carotenoid coloring (Courtesy of Ian Stephen, University of Nottingham)

"There are so many healthy reasons to eat vegetables that it feels redundant to keep enumerating them. But if a stronger immune system, cancer-fighting antioxidants and heart-healthy fiber aren't reason enough for some, perhaps we can appeal to their vanity: a study published in the journal Evolution and Human Behaviour found that eating foods high in carotenoids — a nutrient found in some fruits, leafy greens and root vegetables — gave them a healthy glow that rivaled a sun tan and made them more attractive in tests."

"We found that, given the choice between skin color caused by suntan and skin color caused by carotenoids, people preferred the carotenoid skin color," Dr. Ian Stephen, the study's lead researcher, now of the School of Psychology, University of Nottingham, Malaysia Campus, said in a statement.

"So if you want a healthier and more attractive skin color, you are better off eating a healthy diet with plenty of fruit and vegetables than lying in the sun."

Much of the good in this world comes when ordinary people have the courage to do the right thing--in spite of the risks to their reputation or financial security. In spite of ridicule, dismissal, censure, or pressure from family & friends. It's so much easier to leave things as they are, and not make waves.

-This one's from me--based on the articles, movies, & even the cookbook author mentioned in this post-

If you received this post via email, click here to get to the web version with all the links.

I probably won't have much time to post over the next 10 days. I'm going to play & hang out with our gorgeous 19-month old "little man".

So, I'm leaving you with some homework to do while I'm gone.

I've got four articles for you to read. Two have certainly set my head spinning--and two have cleared things up nicely for me. Now I want to know what you think of them.

I'm also leaving you with four movies to see. All four are true stories about ordinary people who did what they knew was the right thing to do. It would have been a whole lot easier to sit back, stay at home, give up, or shut up. Oh, and I'm also giving you a link to some excellent thought-provoking movies for grown-ups. It's cold, the days are short--the perfect time for a delcious dinner & a movie night.

I've got a good recipe, too! A rib-sticking-nutritious-comfort soup based on a Mark Bittman creation.

All the articles--the movies--and even the recipe could be posts of their own. But, I've run out of time--got some grandson book shopping to do, plus some laundry, some packing, and a whole lot more..

The Homework Articles

The New York Times Interviews Dr. T. Colin Campbell--"Nutrition Advice from the China Study" 1/7/11. Click here for this quick read interview by NYT writer, Tara Parker-Pope.

Campbell's a man who has stellar academic & research credentials--but he's put them all on the line, risking censure & reputation--to speak out about the damaging toll our American diet is taking on our health. The U.S. meat & dairy boards wish he'd just shut up & go away.

"Six years ago a small Texas publisher released an obscure book written by a father-son research team. The work, based on a series of studies conducted in rural China and Taiwan, challenged the conventional wisdom about health and nutrition by espousing the benefits of a plant-based diet.

To everyone’s surprise, the book, called “The China Study,” has since sold 500,000 copies, making it one of the country’s best-selling nutrition titles. The book focuses on the knowledge gained from the China Study, a 20-year partnership of Cornell University, Oxford University and the Chinese Academy of Preventive Medicine that showed high consumption of animal-based foods is associated with more chronic disease, while those who ate primarily a plant-based diet were the healthiest."

Vanity Fair, January 2011. "Politics - Deadly Medicine," by Donald L. Barlett and James B. Steele. Click here for the article. My sister-in-law said I had to read this one. She was right. Disturbing, to say the least. I've passed it on to some doctor friends to get their opinions--is this truth, or just an over-exaggerated scary story to sell magazines?

I would love to hear what Dr. Steve Nissen has to say about it. But, this much I do know--if the piece is true, the only way it could have been written was because of the courage of those insiders who chose to do the right thing--and speak out. Truth or lie? Or a bit of both?

"Prescription drugs kill some 200,000 Americans every year. Will that number go up, now that more clinical trials are conducted overseas—on sick Russians, homeless Poles, and slum-dwelling Chinese—in places where regulation is virtually nonexistent, the F.D.A. doesn’t reach, and “mistakes” can end up in pauper’s graves? The authors investigate the globalization of the pharmaceutical industry, and the U.S. Government’s failure to rein in a lethal profit machine."

"Overall, deaths from F.D.A.-approved prescription drugs dwarf the number of people who die from street drugs such as cocaine and heroin. They dwarf the number who die every year in automobile accidents. So far, these deaths have triggered no medical crusades, no tough new regulations. After a dozen or so deaths linked to runaway Toyotas, Japanese executives were summoned to appear before lawmakers in Washington and were subjected to an onslaught of humiliating publicity. When the pharmaceutical industry meets with lawmakers, it is mainly to provide campaign contributions.

And with more and more of its activities moving overseas, the industry’s behavior will become more impenetrable, and more dangerous, than ever."

NPR's Living on Earth, "Sex and Endocrine Disruptors," by Ashley Ahearn, January 7, 2011.Click here for the story. Meet the physicians & lab researchers who are wondering if the ubiquitous chemicals in our environment may be causing serious changes to the reproductive systems of infant boys--and perhaps even affecting sexual orientation. These changes have been seen in frogs & fish for years--but what about in humans? Researchers in this field now have concerns that common synthetic chemicals might be responsible for feminizing effects, as well as genital birth defects in male children. An abnormality of the male infant genitalia--called hypospadias--is now the second most common birth defect in the country, behind heart defects. Is there a chemical connection?

AHEARN: Talking about problems with reproductive health is something society has never handled well. And perhaps because most hypospadias can be corrected with surgery, very few doctors have raised questions about the underlying causes of this birth defect.

But endocrine disrupting chemicals show up in almost 100 percent of the population, according to the Centers for Disease Control, and many of these chemicals are known to disrupt normal reproductive system development in animals - think back to Tyrone Hayes' frogs here.

So I asked Dr. Theo Colborn, who's been studying endocrine disruptors for over 30 years, if she thought our environmental exposures could be affecting our reproductive health. Or more specifically, given what we're seeing with hypospadias, I asked her, do you think we are feminizing our baby boys?

COLBORN: I definitely do. I think there's a certain percentage that are definitely being affected and there's no denying it.

Manson is the principal investigator in the upcoming VITAL Trial, which is set to follow 20,000 healthy older men & women for 5 years--testing the health effects of daily taking 2000 IUs of vitamin D3 & 1 gram of marine omega-3 against that of placebos. Manson also took part in the Institute of Medicine's recent revision of the guidelines for vitamin D. She's an outspoken physician/researcher who carefully sifts through study minutiae before she comes to any conclusions. If you want an excellent, balanced, and thorough explanation of the vitamin D research, read this article. For more on the VITAL STUDY, click here.

"Although vitamin D supplementation appears to be a promising intervention for reducing risks of cancer, cardiovascular disease, and other chronic diseases, existing evidence on its benefits and risks is limited and inconclusive. Recruitment is now under way for the Vitamin D and Omega-3 Trial (VITAL), the first large-scale randomized clinical trial of these nutritional agents for the primary prevention of cancer and cardiovascular disease.

3. Some observational studies indicate there may be a threshold for vitamin D intake above which there is no increase in benefit and which may increase risk.

4. The VITAL trial is currently randomizing 20,000 healthy older men and women throughout the United States to receive either 2,000 IU of vitamin D3 (cholecalciferol) per day or placebo, as well as 1 g of marine omega-3 fatty acids per day or placebo, for 5 years."

The Movies - Ordinary People with the Courage to Change Themselves and Sometimes the World

Made in Denhagen

The remarkable, funny, and inspiring true story of women fighting for equal pay in a Ford Motor Company in 1968 England. Rita O'Grady is the woman of courage in this film. Click here to read more. I loved it!

The Fighter

A combination biopicture and dramedy that has us rooting for a working-class hero as he struggles to find his style in the ring and outside the ring within his dysfunctional family. Dickie Eklund and his half brother, Mickey Ward are the men with a more personal kind of courage in this film--the courage to change the direction of their lives and to stand up for themselves. Click here to read more. I loved it!

The King's Speech

An enthralling and heart-stirring biodrama about an unusual friendship that transforms the life and soul of King George VI of England. England's about to go to war against Germany, they're in the middle of the Depression, and the country is feeling anxious & dispirited. In the midst of this uncertainty, Prince Edward cavalierly gives up his claim to the throne, leaving his brother, Prince Albert, with no choice but to become King of England. Against all odds Prince Albert has the courage to accept the position--overcome a severe stutter--and take a key role in uniting and lifting up the spirits of his countrymen. Click here to read more. I loved it!

Forks Over Knives

This documentary film tells the story of the courage of Dr. T. Colin Campbell & Dr. Caldwell Esselstyn. Both have stood steadfast in their position that our Western diet is hazardous to our health--and that many of our present day chronic diseases are "nothing more than food-borne illnesses" that could be cured if only we'd change our diets.

Campbell & Esselstyn are both in their mid-seventies, and they are no longer beholden to any academic, medical, or governmental institutions--nor are they concerned about damaging their reputations--they are free to speak the truth. They aren't motivated by financial gain, or fame. They are unassuming, approachable, and motivated only by wanting to share what they have learned. They don't have to do this!

I've seen the film--and can say without a doubt, it's a must-see! It officially opens nationally in March 2011, but there have been previews all over the country. For an updated list of previews in your area, click here.

To read my summary of the film, "The Research-Based Documentary That Will Change the Way You Eat. "Forks Over Knives" The Story of Dr. T. Colin Campbell's China Study & Dr. Caldwell Esselstyn's Heart Disease Reversal Study. Getting Your Health Back on a Plant-Based Whole Foods Diet," click here.

For links to some top thought-provoking movies for grown-ups--those currently playing--and the best films of 2010--click here.

This recipe is based on one I found in Mark Bittman's, The Food Matters Cook Book. Bittman's a long-time food writer for the New York Times--and he's taken some courageous steps as a food writer in recent years. For a guy who make his living from food--writing, cooking and eating--Bittman risked a lot when he make a 180 degree change in his own eating habits.

"I've been eating like Food Matters--the title of this book's predecessor, a book that encourages us to concentrate on eating more plants and few animal products and processed foods--for three years. If you swap the basic proportions in your diet--increasing unprocessed fruits, vegetables, legumes, nuts, and whole grains--you'll wind up losing weight and improving your overall health while also improving more difficult-to-measure situations like global warming, the environment in general, and animal welfare." Mark Bittman

Miso Soup with Bok Choy, Soba Noodles, and Tofu (or salmon) click here for a copy of the recipe on one page

2. Prep the tofu. Drain the water from the package, and cut the block into thirds, horizontally. Wrap the three slices in a tea towel & put a heavy pot or weight on top of it to press. After 30 minutes, cut each slice into 4 triangles, & spread one side with the sauce of your choice.

3. Add the soba noodles to the boiling water and cook until tender but not mushy, 3 to 5 minutes. Drain, reserving 2 cups of the cooking liquid, and rinse the noodles with lots of cold water until cool.

4. Put 4 cups of vegetable broth into the pot, along with the 2 cups of reserved "noodle liquid", and set it to boil again--you'll have 6 cups of liquid.

5. Heat up a stove-top grill pan on high, and when it's hot, add the tofu triangles, sauce side down. Spread top of tofu with sauce. Watch carefully--it doesn't take too long for the tofu to nicely brown (as shown). Flip when the tofu is browned with grill marks. If using salmon, sprinkle with seasoning & either pan-fry without oil, or grill it. Tofu won't stink or smoke up your kitchen! Trust me on this one.

6. When the water in the pot is almost boiling, put the miso in a small bowl, ladle in a cup or so of the heated broth, and whisk it until it's smooth.

7. When the broth is boiling, add the bok choy stems to the pot and let them cook for about a minute. Add the bok choy "ribbons" and continue cooking, adjusting the heat so the soup bubbles steadily, until the bok choy gets silky, 3 to 5 minutes more.

8. Turn the heat down to low, pour the miso mixture into the pot along with the soba noodles, and heat just long enough to warm everything, only a minute or two. Taste, adjust the seasoning.

9. Serve the soup immediately, topping with 3 tofu triangles each (or 1/4 of the salmon), and sprinkle with sesame seeds, and scallions.

April 06, 2010

Click here for the web-version of this post with all the links if you've received this via email

"My view has always been that you start with the basics--and do the simple things before you go to drugs. Lots of people are not doing the sensible things. They're not eating the right diet, they're not exercising, they're still smoking. It is so much easier to prescribe a drug than to change behavior, and that is my worry. We're heading down that road. Cardiovascular risk prevention is moving in the wrong direction."

"You have to go with the scientific evidence. A clinical trial was done and there was a substantial reduction in morbidity and mortality in people treated with this drug (Crestor). This is one example where the FDA got it exactly right."

"(The key issue is) Millions of healthy American women are taking statins, which have never been shown to reduce myocardial infarction or lengthen life and have an untold number of side effects, worse in women than men."

-Dr. Rita Redberg, Cardiologist, Director of the Women's Cardiovascular Services, University of California, San Francisco-

"Muscle
problems are the best known of statin drugs' adverse side effects. But
cognitive problems and peripheral neuropathy, or pain or numbness in
the extremities like fingers and toes, are also widely reported."

In Case You Missed It - There's Been Big News Breaking in the Statin World Recently

Here's the timeline:

November 9, 2008: Landmark JUPITER Study rocks the American Heart Association Conference. Evidence
was presented that will forever change the standards for testing CRP
levels (C-Reactive Protein--a measure of inflammation) and prescribing statins to prevent heart attacks & strokes
in healthy individuals. The JUPITER (Justification for the Use of Statins in Primary Prevention) Study looked at almost 18,000 men & women with low LDL levels (median 108 mg/dL), and CRP levels greater than 2.0 mg/L.

"The group that was put on a moderate dose of statins (20 mg of Crestor) decreased their cholesterol levels, lowered their CRP levels, reduced their triglyceride levels and cut their risk of heart attack and stroke in half."

To read the full reportclick here.To the read the accompanying article published in the New England Journal of Medicine,click here.

To read my post that explains the JUPITER study and the non-statin ways to treat inflammation, click here

February 9, 2010: Crestor is Approved for Use in Healthy People for Prevention. Based on the landmark results of the JUPITER Study (which was sponsored by Crestor's maker--AstraZeneca) the FDA approved Crestor--for the prevention of heart disease or stroke in people with normal or near-normal cholesterol levels.

"The new indication is for reducing the likelihood of a heart attack
or stroke or the need for a procedure to treat blocked or narrowed
arteries in patients who have never been told they have heart disease
but are nevertheless at increased risk of a cardiac event.

Specifically, this includes men 50 years of age and older and women
60 years of age and older who have an elevated amount of a substance
known as high sensitivity C-reactive protein (CRP) in their blood and at
least one additional traditional cardiovascular risk factor such as
smoking, high blood pressure, a family history of premature heart
disease, or low amounts of high-density lipoprotein or HDL cholesterol,
the so-called “good cholesterol.”' Click here Q & A from the FDA about the new approval.

February 16, 2010: Statins and Risk of Diabetes.Article published in Lancet finds there is a 9% increased risk of developing diabetes associated with statin use. The risk is highest in older patients, but it had no relation to their BMI (weight), or their LDL levels. According to the authors, "No worries! The benefit of taking statins to reduce cardiovascular risk outweighs the risk of developing diabetes by 9:1" OK, if you say so.

March 29, 2010: Do Statins Benefit Women? TIME Magazine article appears, "Do Statins Work Equally for Men and Women?" by Catherine Elton. It's a must-read article for women who are taking statins for prevention--not because of diagnosed heart disease--or a previous cardiac event.

In light of the FDA's recent approval of Crestor for primary heart disease prevention in healthy men & women--Elton looked at the research, and interviewed cardiologists and statin-users to find out if it makes sense for healthy women to start taking statins strictly for prevention. Turns out that the majority of current statin users are already healthy people who don't have heart disease but simply have high cholesterol--and this is before Crestor even got it's "prevention approval".

Dr. Scott Grundy of the University of Texas Southwestern Medical Center in Dallas has been a long-time advocate of prescribing statins to women who are at moderate risk of heart disease & he says the benefits outweigh the risks. Dr. Rita Redberg of UCSF, and Dr. Beatrice Golomb of UCSD, who is one of the world's experts in the adverse effects of statins, think otherwise. Golomb thinks "many doctors may be so unfamiliar with the side effects of statins that they deny their connection to the drugs, and that may contribute to the under-filing of adverse-drug-reaction reports with the FDA."

The two examples of "statin horror stories" that Elton reports on in her article are certainly anecdotal--but may put "statin-doubts" into many who read her article:

"Lynne Newhouse Segal was the picture of robustness. At 59, the slim
former lawyer was an avid runner, golfer and yoga practitioner. Segal,
who lives in San Francisco, was healthy by nearly every measure —
except her cholesterol level, which a routine test four years ago
revealed was high. High cholesterol is a key risk factor for heart
disease, especially in a patient Segal's age and with her family
history (several close relatives had had heart attacks), so her doctor
put her on a cholesterol-lowering statin drug as a preventive measure.

But Segal's statin ended up preventing her from living a heart-healthy
lifestyle. A month after she started taking the drug, she suffered
muscle pain so severe, she had to stop all physical activity and was
unable to sleep at night. Although her husband, who was worried about
her risk of heart attack, pleaded with her to stay on the drug, she
discontinued using it. The muscle pain receded. "My husband was scared
for me. Doctors scare you. But I was in so much pain, I told him I
would have rather died than stay on them," says Segal.

And then there's Margaret--a 59 year old woman who asked that her last name be withheld. She says her experience with statin side effects was harrowing. Margaret was in
her early 50s and had high cholesterol and diabetes when her doctor put
her on statins. Soon after, she says, she forgot how to do basic math
and got lost driving to familiar places. But when she described the
symptoms, she says, her doctor refused to believe they were related to
the drugs. "I felt like I was going crazy," says Margaret, "but within
a week or two of stopping the statins, my brain started to work again."

For more on the cognitive side effects of statins, read click here"Do Statins Make Your Stupid? Asks Wall Street Journal & New York Times"

March 30, 2010: The Heartwire responds to Elton's Time Magazine article, with one of their own, "Time Magazine Questions Statin Risks and Benefits in Women, But Experts Say Drugs Safe and Effective" click here to read it. The overwhelming tenor of the article is pro-statin, but it's interesting that every physician that was interviewed--except for Dr. Rita Redberg who is anti-statin for primary prevention in women--is affiliated with one or more pharmaceutical companies. The best part of the Heartwire article is the wide mix of pro- and con- comments that follow it. Take a look.

March 30, 2010: The New York Times business section reports, "Risks Seen in Cholesterol Drug Use in Healthy People" by Duff Wilson. Not to be missed are the 424 comments (many on side effets) that follow this article. The NYT stopped accepting comments within 1 day of publishing Wilson's article. The following is an excerpt of Wilson's article:

"With the government’s blessing, a drug giant is about to expand the market for its blockbuster cholesterol medication Crestor to a new category of customers: as a preventive measure for millions of people who do not have cholesterol problems.

Some medical experts question whether this is a healthy move.

They point to mounting concern that cholesterol medications — known as
statins and already the most widely prescribed drugs in the United
States — may not be as safe as a preventive medicine as previously believed for people who are at low risk of heart attacks or strokes.

Statins have been credited with saving thousands of lives every year with
relatively few side effects, and some medical experts endorse the
drug’s broader use. But for healthy people who would take statins
largely as prevention — which would be the case for the new category of
Crestor patients — other experts suggest the benefits may not outweigh
any side effects."

The FDA approved the new criteria last month for Crestor, which is made by AstraZeneca and is the nation’s second best-selling statin, behind Lipitor by Pfizer.
AstraZeneca plans soon to begin a new marketing and advertising
campaign for Crestor, based on the new F.D.A.-approved criteria.

Under those criteria, an estimated 6.5 million people in this country
who have no cholesterol problems and no sign of heart problems will be
deemed candidates for statins. That is in addition to the 80 million
who already meet the current cholesterol-based guidelines — about half
of whom now take statins.

Some patients have long complained of muscle aches from taking statins. Doctors,
though, have generally seen those risks as being more than offset by
the drugs’ benefits for people with high levels of “bad” cholesterol
and a significant risk of cardiovascular disease.

But then came the unexpected evidence linking statins to a diabetes risk, reported last month in the British medical journal The Lancet.
That report was based on an analysis of most of the major clinical
studies of statins — including unpublished data and the results of the
Crestor study that the F.D.A. reviewed.

“We’ve had this drug for a
while, and we’re just now finding out that there’s this diabetes
problem with it?” said Dr. Mark A. Hlatky.

“It just turns a
lot of healthy people into patients and commits them to a lifetime of
medication.”'

Last June I summarized the current research on the side effects of statins. Now just might be a good time to revisit it--if you take statins, are basically healthy, and do not have heart disease. Click here to read that post.

What The Experts Say About The Side Effects Of
Statins. What Are They? What Causes Them? Who Is Most At Risk? How Are
They Treated? June 27, 2009